Strategic Director: Provider Relations & Resolution

L.A. Care; Los Angeles (CA); On-site; USD 150,000 - 254,000; Full time

Benefits offered by this job

Paid Time Off (PTO)

Tuition Reimbursement

Retirement Plans

Medical, Dental and Vision

Wellness Program

Job summary

L.A. Care Health Plan in Los Angeles, CA seeks a Director of Provider Relations and Resolution Management to lead provider-facing operations and ensure timely issue resolution. The role oversees a team, aligns with regulatory requirements, and drives proactive provider satisfaction improvements.

Responsibilities include process design, cross-functional collaboration, and strategic leadership to strengthen networks and improve member outcomes across Medi-Cal, Medicare, and other programs.

Qualifications

• At least 8 years of progressive experience across health plan, managed care, hospital, physician organization, IPA, or provider relations settings.
• At least 6 years of experience leading staff, supervising and/or managing people.
• At least 5 years of provider-facing leadership with executive-level relationships and complex issue resolution.
• Experience with Medi-Cal, Medicare Advantage, DMHC, DHCS, CMS, and NCQA requirements is preferred.

Responsibilities

• Leads all core provider-facing interactions, ensuring onboarding and ongoing education on policies and tools.
• Oversees provider satisfaction indicators, addressing disputes and recurring operational challenges.
• Manages the full lifecycle of provider issues from intake to final resolution and post-resolution validation.
• Collaborates with cross-functional teams to identify root causes and deploy system-wide solutions.
• Mentors a high-performance provider relations team and manages hiring, performance reviews and budget.

Skills

Managed care operations

Leadership

Root-cause analysis

SLA governance

Stakeholder relations

Negotiation

Education

Bachelor's Degree

Master's Degree

Job description

L.A. Care Health Plan in Los Angeles, CA seeks a Director of Provider Relations and Resolution Management to lead provider-facing operations and ensure timely issue resolution. The role oversees a team, aligns with regulatory requirements, and drives proactive provider satisfaction improvements.

Responsibilities include process design, cross-functional collaboration, and strategic leadership to strengthen networks and improve member outcomes across Medi-Cal, Medicare, and other programs.