As one of the nation’s largest not-for-profit Medicare Advantage
plans, serving more than 200,000 members in California, SCAN Health
Plan has been a mission-driven organization dedicated to keeping
seniors healthy and independent for over 40 years. SCAN employees
are passionate about what they do, and understand that success is
based on achieving the mission. Employees are afforded with the
training and tools necessary to do their jobs and are rewarded for
their efforts and recognized as experts in their fields. To learn
more, visit scanhealthplan.com or follow us on social media:
LinkedIn ; Facebook ; and Twitter .
To support the department objectives and provider networks
through contract negotiations that are not only compliant and
financially viable, but also aligned with company vision metrics.
Build and maintain positive relationships with Providers in a
designated geography (including Medical Groups, IPA’s Hospitals,
Physicians, and Providers) while managing their service needs and
adhering to regulatory requirements. Collaborate with internal SCAN
departments to ensure quality and access to care for our
Serves as SCAN's primary point of contact for assigned
Enhances the effectiveness of assigned providers' programs by
recommending process improvements, supporting the establishment of
operational guidelines, and providing contract monitoring support
and assistance as needed.
Enhances the relationship with assigned provider’s effectively
responding to requests for information, monitoring and influencing
provider performance, and successfully resolving issues related to
capitation, claims, and other operational functions.
Assists with ongoing network and provider analysis by
researching new areas for development and reviewing current service
areas to determine need for additional providers. Creates
presentations, drafts proposals and other business correspondence,
and prepares reports to assist with network expansions.
Provides administrative support and coordination for all
Supplemental, Ancillary, Group and Independent Living Power (ILP)
contracts in order to increase program efficiencies. Performs a
wide variety of tasks, including letter and form development,
verbal and written correspondence flow charts, task tracking,
research, data summary, etc.
Participates in the re-negotiation of contracts and drafts
Maintains on-going contract communications, internal and
external, for all programs by establishing and completing data
tracking and communication instruments in a timely and correct
manner. Maintains the provider contracting, reporting and
monitoring process (InteliContract, LSA, NCN, etc).
Coordinates SCAN regulatory and policy compliance and audit
activities with assigned providers. Facilitates and monitors
communications between SCN internal departments and providers,
reviews audit results, tracks provider progress to compliance goals
and recommends appropriate action for continued noncompliance.
Maintains internal SCAN awareness of network changes by issuing
timely and accurate Provider Bulletin communications about
contractual risk disposition changes, provider terminations and
additions, and panel closures.
Supports efforts of Network Management by collaborating with
external departments within SCAN, and participating in
interdepartmental meetings and selected committees.
Participates in internal company initiatives/projects and/or
process improvement endeavors.
Demonstrates knowledge of regulatory compliance issues as they
relate to provider contracts. Successfully conveys the need for
regulatory and contract changes to providers.
Ensures SCAN overall compliance by responding to
grievances/appeals and adhering to regulatory and departmental
Policy and Procedure guidelines and timeframes.
Maintains professional and technical knowledge by attending
educational workshops; reviewing professional publications;
establishing personal networks; participating in professional
Contributes to team effort by accomplishing related results as
Actively supports the achievement of SCAN’s Vision and
Bachelor's Degree in Business Administration or related
2+ years of experience with provider service operations
Health care experience required.
Contract negotiation experience preferred.
Strong quantitative, written and oral communication skills
including presentations, negotiations and interpersonal skills
Strong multi-tasking and organizational skills with minimal
Ability to execute work under pressure and tight deadlines.
What's in it for you?
A competitive compensation and benefits program An annual
employee bonus program Robust Wellness Program Generous
paid-time-off (PTO) Ten paid holidays per year Excellent 403(b)
Retirement Saving Plan with employer match Business Casual attire
Robust employee recognition program A work-life balance and much
more! We're always looking for talented people to join our team.
Qualified applicants are encouraged to apply now!
SCAN is an equal opportunity employer. All qualified applicants
will receive consideration for employment.
Equal Opportunity Employer/Protected Veterans/Individuals with
The contractor will not discharge or in any other manner
discriminate against employees or applicants because they have
inquired about, discussed, or disclosed their own pay or the pay of
another employee or applicant. However, employees who have access
to the compensation information of other employees or applicants as
a part of their essential job functions cannot disclose the pay of
other employees or applicants to individuals who do not otherwise
have access to compensation information, unless the disclosure is
(a) in response to a formal complaint or charge, (b) in furtherance
of an investigation, proceeding, hearing, or action, including an
investigation conducted by the employer, or (c) consistent with the
contractor’s legal duty to furnish information. 41 CFR