Remote Provider Relations Lead

SCAN Health Plan; Long Beach (CA); Remote; USD 72,000 - 123,000; Full time

Benefits offered by this job

Annual bonus

Wellness program

PTO

Holidays

401(k) match

Remote work

Tuition reimbursement

Employee recognition

Job summary

SCAN Health Plan is seeking a Provider Relations Lead to strengthen provider relationships across Southern California. The role focuses on executing performance initiatives, engaging providers, and driving KPIs such as star ratings, cost of care, and regulatory compliance.

The ideal candidate has 5+ years in healthcare or Medicare Advantage, strong data analysis, and cross-functional collaboration skills, with a mostly remote work mode and competitive benefits.

Qualifications

• 5 years of healthcare or Medicare Advantage experience.
• Bachelor's Degree or equivalent experience preferred.
• Provider relationship management experience.
• Data interpretation and performance analysis skills.
• Medicare Advantage and Star quality knowledge.
• CMS regulatory and compliance awareness.
• Ability to manage multiple priorities in a fast-paced environment.
• Escalation management and issue resolution abilities.
• Operational execution and follow-through.
• Presentation and facilitation skills.
• Cross functional collaboration skills.
• Strong written and verbal communication.
• Strong problem solving and critical thinking capabilities.
• Strong technical skills for Office tools and Visio.

Responsibilities

• Act as the primary operational liaison between SCAN and provider organizations within a defined region.
• Manage FFS network for Southern California.
• Execute and monitor regional provider performance initiatives and KPIs.
• Conduct regular operational touchpoints and Joint Operating Committee meetings.
• Partner with Network Contracting, Operations, Clinical, Quality, Growth, and Analytics teams.
• Support provider onboarding and lifecycle management with Contracting and Operations.
• Investigate and resolve provider escalations and high-risk issues.
• Deliver provider education and training on SCAN programs and regulatory requirements.
• Analyze provider-level data to identify trends and opportunities; drive corrective actions.
• Ensure regulatory and contractual compliance; identify risk areas.
• Support internal communication of network changes and market insights.
• Manage department Provider Relations Inbox.
• Contribute to SCAN’s Vision and Goals.

Skills

Provider relations

Healthcare operations

Data interpretation

CMS regulations

Communication skills

Cross-functional collaboration

Office tools

Education

Bachelor's degree

Equivalent experience

Tools

Microsoft Office

Visio

Excel

PowerPoint

Outlook

Job description

SCAN Health Plan is seeking a Provider Relations Lead to strengthen provider relationships across Southern California. The role focuses on executing performance initiatives, engaging providers, and driving KPIs such as star ratings, cost of care, and regulatory compliance.

The ideal candidate has 5+ years in healthcare or Medicare Advantage, strong data analysis, and cross-functional collaboration skills, with a mostly remote work mode and competitive benefits.