Provider Relations Lead - So Cal

Summary

SCAN is a nonprofit health organization focused on improving care for older adults. The Provider Relations Lead manages and strengthens provider relationships in Southern California, serving as the primary liaison between SCAN and contracted providers. The role drives provider performance initiatives across quality, cost, utilization, access, regulatory compliance, and risk adjustment while resolving issues and coordinating cross-functional efforts.

Responsibilities

• Acts as the primary operational liaison between SCAN and assigned provider organizations (MSOs, IPAs, medical groups, PCPs, specialists, hospitals, and ancillaries) within a defined geographic region
• Will be responsible for managing FFS network for Southern California
• Executes and monitors regional provider performance initiatives aligned to SCAN’s key performance indicators, including Star ratings, cost of care, utilization management, access standards, and quality measures to improve quality, cost, utilization, access and regulatory compliance to enhance quality, cost, etc
• Conducts regular operational touchpoints and Joint Operating Committee meetings with providers to review performance results, identify gaps, and support action planning
• Partners cross-functionally with Network Contracting, Network Operations, Clinical, Quality, Growth, and Analytics teams to ensure coordinated provider engagement and issue resolution
• Supports provider onboarding and lifecycle management in collaboration with Contracting and Operations, ensuring clarity of performance expectations and operational readiness
• Investigates and resolves provider escalations and operational concerns, escalating complex or high-risk issues to senior leadership when appropriate
• Delivers provider education and training related to SCAN programs, policies, regulatory requirements, performance standards, and operational best practices
• Analyzes provider-level data to identify trends and opportunities, supporting corrective action plans and continuous performance improvement efforts. Utilize operational levers to drive performance improvements such as workflow optimization and process enhancements
• Ensures provider alignment with regulatory, contractual, and compliance requirements, proactively identifying potential risk areas
• Supports internal communication of network changes, provider performance updates, and market-level insights to relevant enterprise stakeholders
• Responsible for managing department Provider Relations Inbox
• 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

Skills

• 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
• Provider relationship management experience. Strong experience developing relationships with all provider types
• Data interpretation and performance analysis skills
• Medicare Advantage and Star quality knowledge
• CMS regulatory and compliance awareness
• Ability to manage multiple priorities and concurrent workstreams, effectively multi-task, and remain organized and responsive in a fast-paced dynamic environment
• Escalation management and issue resolution abilities
• Operational execution and follow-through
• Presentation and facilitation skills
• Accountability and ownership mindset
• Strong problem solving skills and critical thinking capabilities
• Strong written and verbal communication and interpersonal skills
• Cross functional collaboration skills. Strong ability to partner with variety of functions across the enterprise
• Strong technical skills for functional area. Advanced Microsoft Office (Word, Excel, PowerPoint, Outlook, Teams, Access) and Visio
• Bachelor's Degree or equivalent experience preferred

Qualifications

Must Haves

• 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
• Provider relationship management experience. Strong experience developing relationships with all provider types
• Data interpretation and performance analysis skills
• Medicare Advantage and Star quality knowledge
• CMS regulatory and compliance awareness
• Ability to manage multiple priorities and concurrent workstreams, effectively multi-task, and remain organized and responsive in a fast-paced dynamic environment
• Escalation management and issue resolution abilities
• Operational execution and follow-through
• Presentation and facilitation skills
• Accountability and ownership mindset
• Strong problem solving skills and critical thinking capabilities
• Strong written and verbal communication and interpersonal skills
• Cross functional collaboration skills. Strong ability to partner with variety of functions across the enterprise
• Strong technical skills for functional area. Advanced Microsoft Office (Word, Excel, PowerPoint, Outlook, Teams, Access) and Visio

Nice to Haves

• Bachelor's Degree or equivalent experience preferred

Benefits

• Mostly Remote
• 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!