Provider Relations Lead - So Cal

The Job

The Provider Relations Lead is responsible for managing and strengthening provider relationships within an assigned geographic region, with a primary focus on executing performance initiatives across quality, cost, utilization, access, and regulatory metrics. This role serves as the primary operational liaison between SCAN and contracted providers, driving performance execution, provider engagement, and the achievement of key performance indicators (KPIs) such as star ratings, cost of care management, and risk adjustment (coding quality).

• 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.
• 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.
• Utilizes 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.
• Maintains the Provider Relations Inbox.

Qualifications

• 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;
• Bachelor's Degree or equivalent experience preferred;
• Provider relationship management experience;
• Data interpretation and performance analysis skills;
• 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 technical skills for functional area;
• Advanced Microsoft Office (Word, Excel, PowerPoint, Outlook, Teams, Access) and Visio.