Provider Relations Lead - So Cal
Core
Managing and strengthening provider relationships within a geographic region to execute performance initiatives across quality, cost, utilization, access, and regulatory metrics.
Role type
Senior provider relations lead (Medicare Advantage)
Builds
FFS network performance and provider engagement for Southern California
Domain
Healthcare / Medicare Advantage / Provider Operations
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Provider relationship management, Medicare Advantage and Star quality knowledge, CMS regulatory compliance, Data interpretation and performance analysis, Cross-functional collaboration, Escalation management, Presentation and facilitation, Advanced Microsoft Office (Word, Excel, PowerPoint, Outlook, Teams, Access, Visio)
Preferred skills
Experience with delegated or risk-based provider arrangements, Experience supporting provider performance improvement initiatives, Experience presenting data to provider or operational audiences
Technologies
Microsoft Office (Word, Excel, PowerPoint, Outlook, Teams, Access, Visio)
Responsibilities
Acts as primary operational liaison between SCAN and assigned provider organizations (MSOs, IPAs, medical groups, PCPs, specialists, hospitals, ancillaries), Executes and monitors regional provider performance initiatives aligned to KPIs (Star ratings, cost of care, utilization management, access standards, quality measures), Conducts regular operational touchpoints and Joint Operating Committee meetings with providers, Partners cross-functionally with Network Contracting, Network Operations, Clinical, Quality, Growth, and Analytics teams, Supports provider onboarding and lifecycle management, Investigates and resolves provider escalations and operational concerns, Delivers provider education and training related to programs, policies, and best practices, Analyzes provider-level data to identify trends and opportunities, Ensures provider alignment with regulatory, contractual, and compliance requirements, Manages department Provider Relations Inbox
Seniority
Senior, hands-on IC
