Provider Relations Lead - Village Health

SCAN Health Plan; Long Beach (CA); Remote; USD 72.000 - 123.000; Vollzeit

Benefits dieser Stelle

Mostly Remote

Annual bonus

Generous PTO

401(k) plan

Zusammenfassung

SCAN Health Plan is seeking a Provider Relations Lead for Village Health in Long Beach, CA. The role focuses on leading onboarding, education, and ongoing engagement of directly contracted providers, including DaVita, to ensure seamless provider experience and robust member access.

You will monitor performance, manage Joint Success Committees, and collaborate with Contracting, Claims, Operations, and Clinical teams to drive Stars and coding quality improvements. Travel may be required.

Qualifikationen

• Bachelor's degree or equivalent experience.
• 5+ years in healthcare or Medicare Advantage operations.
• Experience with provider organizations or network management.
• Experience with Joint Success Committees and provider governance.
• Strong written, verbal, and presentation skills.

Aufgaben

• Serve as primary relationship and operational lead for directly contracted providers (DaVita and others) within Village Health ESRD C-SNP.
• Lead onboarding, education, and ongoing outreach for providers across the network.
• Monitor network adequacy, access, and performance; analyze data to address barriers.
• Drive provider performance against Stars and Coding Quality measures.
• Coordinate cross-functional initiatives to improve provider experience and network performance.

Kenntnisse

Provider relationships

Data analysis

Cross-functional collaboration

Project management

Communication skills

Ausbildung

Bachelor's Degree or equivalent

Tools

SQL

Microsoft Office

Visio

Jobbeschreibung

Provider Relations Lead - Village Health# SCAN Careers## Provider Relations Lead - Village HealthApply: Long Beach, CA: Full time: Posted Yesterday: JR3871Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do.Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults.Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity.At SCAN, we believe scale should strengthen—not dilute—our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve. **FUTURE NEED - Please Note:** This is an evergreen posting, which means that while we might not have an immediate opening today, we are always looking for great talent and actively building a pipeline for future opportunities. We hire for this role on a rolling basis, so we’ll keep your application active. Our recruiting team will review your qualifications and reach out should a matching position become available. **If you want to be first in line for our next opening, we highly encourage you to apply**!**The Job**The **Provider Relations Lead - Village Health** is responsible for leading the relationship and operational performance of directly contracted fee-for-service specialists, hospitals, ancillary providers and key strategic partners serving members assigned to Village Health ESRD C-SNP and other products or programs that utilize the same direct contracted referral network. This role improves the onboarding experience for new directly contracted fee-for-service providers and shifts provider engagement from issue-driven intervention to a planned model of education, outreach, access monitoring, payment escalation and proactive relationship management. The Provider Relations Lead owns the DaVita relationship, and associated Joint Success Committees, network operations cadence, commitments, cross-functional escalations and issue resolution, while partnering with Contracting, Claims, Operations, Clinical, Network Management and other stakeholders to deliver a coordinated provider experience and reliable member access.The job entails partnering closely with cross-functional internal stakeholders to ensure an integrated, seamless provider experience and lifecycle management experience for providers servicing Village Health. The role will be responsible for conducting provider awareness and orientation about SCAN Health Plan, ongoing education and outreach, relationship building with office staff and providers, and quarterbacking the overall relationship including acting as the liaison with cross-functional stakeholders across reporting needs, performance monitoring, issue resolution, and clinical programs or growth efforts with the provider.The Provider Relations Lead will be critical in driving relationship management with the Village Health providers across DaVita and directly contracted referral network providers along with the operational staff at each of these entities. This individual will perform ongoing operational touchbases with the providers, own developing effective Joint Success Committee content and driving those conversations, and be the key lead in executing on performance across market key performance indicators such as Star measures and coding quality.There will be daily interface with office staff and providers, as well as interactions with corporate leadership at DaVita and constant collaboration with internal stakeholders to effectively establish and maintain a positive provider experience and resolve escalated issues in a timely manner for Village Health members. As such, occasional in-person office visits may be required based on business needs.**You Will*** Serve as the primary relationship and operational lead for directly contracted specialists, hospitals, ancillary providers, DaVita, and other strategic partners supporting Village Health ESRD C-SNP and other products or programs utilizing the direct contracted referral network, including Embrace I-SNP.* Lead onboarding and lifecycle management for directly contracted fee-for-service providers, coordinating readiness, orientation, education, access, claims, payment, data exchange, and operational requirements with cross-functional partners.* Create and deliver provider-facing education, presentations and communications that clarify SCAN requirements, workflows, resources and program expectations; develop and execute proactive outreach and engagement strategies that strengthen provider relationships and ongoing operational support.* Own the DaVita relationship and Joint Success Committee cadence, including meeting content, operational priorities, commitments, action tracking, data exchange needs, escalations, and leadership follow-through.* Monitor and analyze network adequacy, access, provider availability, referral-network performance, claims, payment, and operational data to identify trends, address barriers, and support timely member access to care.* Lead cross-functional resolution of complex provider issues and escalations, including claims, payment, access, and operational concerns, ensuring clear ownership, communication, and timely closure.* Establish and maintain strong relationships with provider leadership, office staff, and operational teams through structured touchpoints, operational meetings, onsite visits, and virtual engagement to drive performance and operational efficiencies.* Drive provider performance against key market, cost, and quality measures, including Stars and Coding Quality, using data to prioritize interventions, execute initiatives, measure outcomes, and reinforce accountability.* Coordinate regulatory, contractual, network, and operational requirements for assigned providers and serve as a key liaison across Contracting, Claims, Operations, Clinical, Network Management, and other stakeholders to support network changes, clinical programs, and growth initiatives.* Support cross-functional initiatives, projects, and process improvements that strengthen provider experience, Village Health network performance, and SCAN’s Ways of Working.* We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.* Actively support the achievement of SCAN’s Vision and Goals.* Other duties as assigned.**Your Qualifications*** Bachelor's Degree or equivalent experience* 5 years of relevant healthcare or Medicare Advantage experience; experience working with provider organizations or healthcare operations; experience with delegated or risk-based provider arrangements; experience supporting provider performance improvement initiatives; experience presenting data to provider or operational audiences.* Knowledge of fee-for-service provider operations, provider contracting, claims and payment workflows, network access and referral-network management* Experience managing complex provider and strategic partner relationships, including Joint Success Committees and recurring operational governance, as well as driving Star & Coding Quality* Ability to lead cross-functional escalations, establish clear ownership and drive complex operational issues through resolution* Strong analytical skills and ability to use access, claims, payment and operational data to identify trends and prioritize interventions* Strong written, oral and presentation skills, including the ability to communicate with provider leadership, office staff and internal executives* Ability to design and execute provider onboarding, education and outreach strategies* Ability to travel for provider and partner meetings and conduct onsite relationship management* Strong organization, follow-through and project management skills with minimal supervision* Ownership mentality and ability to perform under pressure and tight deadlines* Ability to collaborate across Contracting, Claims, Operations, Clinical, Network Management and other functional areas* Technical expertise - Strong technical skills for functional area* Problem Solving - Strong problem solving skills and critical thinking capabilities* Communication - Strong communication and interpersonal skills* Cross functional collaboration - Strong ability to partner with variety of functions across the enterprise* Relationship management - Strong experience developing relationships with all provider types* Advanced Microsoft Office Suite, Visio, and SQL skills are required.**What's in it for you?*** Base salary range: $71,700 to $123,490 per year* Work Mode: Mostly Remote with Travel in Assigned Territory* An annual employee bonus program* Robust Wellness Program* Generous paid-time-off (PTO)* Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday* Excellent 401(k) Retirement Saving Plan with employer match and contribution* Robust employee recognition program* Tuition reimbursement* An opportunity to become part of a team that makes a difference to our members and our community every day!We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!At **SCAN** we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.**SCAN** is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.#LI-MS1#LI-Hybrid**Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities***The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)*