Provider relations and performance specialist ii

Salary Range: $77,265.00 (Min.) - $100,445.00 (Mid.) - $123,625.00 (Max.)

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

Job Summary

9 open positions:

The Provider Relations and Performance Specialist II is a key driver of provider engagement and operational excellence. This position builds purposeful, transparent relationships with providers, ensuring alignment with organizational goals. The Specialist II strengthens provider relationships and accountability by supporting onboarding, guiding providers through health plan operational processes, and accurately documenting concerns and issues for timely escalation and resolution.

The Specialist manages structured issue intake and proactive communication to provide timely updates to providers and internal stakeholders, support efficient issue resolution, and identify opportunities for continuous improvement. This position collaborates across departments to identify and remove administrative barriers, improve operational processes, and support overall provider, member, and organizational performance.

Duties

• Fosters collaborative relationships with the organization’s provider network, aligning provider engagement activities with strategic objectives, and supporting operational excellence across the network.
• Manages provider onboarding and orientation activities by delivering clear, actionable education on policies, workflows, and essential tools. Guides providers through administrative requirements, operational updates, and process changes, while maintaining documentation of provider inquiries, concerns, and recurring issues to support timely escalation and resolution.
• Identifies recurring provider concerns and operational trends and escalates systemic or complex issues to appropriate business areas. Ensures provider concerns are accurately categorized and documented. Participates in operational meetings. Provides timely status updates to providers and internal stakeholders throughout the issue resolution process, ensuring transparency, maintaining accountability, and fostering trust in provider relationships.
• Collaborates across internal teams to communicate provider questions and concerns, identify administrative barriers, monitor progress toward issue resolution, and gather and share provider feedback to support continuous improvement and enhance organizational performance.
• Monitors provider activities for alignment with contractual, operational, regulatory, and organizational requirements and escalates potential compliance concerns as appropriate.
• Performs other duties as assigned.

Duties Continued

Education Required

Bachelor's Degree in Healthcare Administration or Related Field. In lieu of degree, equivalent education and/or experience may be considered.

Education Preferred

Experience

Required: At least 3 years of experience in a health plan, managed care, hospital, physician organization, Independent Practice Association (IPA), or provider relations environment.

Preferred: Experience with Medi‑Cal, Medicare Advantage, Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services (CMS), and National Committee for Quality Assurance (NCQA).

Skills

Required:

• Working knowledge of managed care operations and delegated risk arrangements.
• Strong communication, relationship‑building, and problem‑solving skills.
• Ability to document provider concerns clearly and categorize issues appropriately.
• Strong teamwork, accountability, adaptability, and customer-focused service skills, with the ability to collaborate effectively, respond to changing priorities, and deliver high-quality support to providers and internal stakeholders.

Preferred: Knowledge of provider contracting and health system partnerships.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Light

Additional Information

Required: Travel to offsite locations for work required.

Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

L.A. Care offers a wide range of benefits including

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retirement Plans
• Medical, Dental and Vision
• Wellness Program
• Volunteer Time Off (VTO)