SCAN

• Create, validate and setup data strategy for marketing acquisition team across budget and performance with an eye towards future-proofing • Ensure data integrity and compliance with privacy regulations • Lead development and drive evolution of dashboards, reports, and KPIs to track marketing performance • Collect, analyze, and interpret marketing data from multiple sources (CRM, digital platforms, sales reports) • Create and organize complex data in excel spreadsheets to enable analysis • Collaborate with cross-functional teams (Marketing, Sales, Finance) to align analytics with business objectives • Provide actionable insights to improve customer acquisition, retention, and engagement • Support forecasting, budgeting, and ROI analysis for marketing initiatives

• Coordinate end-to-end provider onboarding and offboarding management: Project manage all cross-functional tasks and deliverables associated with the provider onboarding, including pre-delegation audits, roster loading and display, MFT setup, claims payment configuration, and reporting activation to ensure seamless onboarding experiences. • Manage provider offboarding processes: Ensure smooth offboarding when a provider terminates or changes MSO affiliation by coordinating member reassignment, provider data removal, report deactivation, and compliant member communication in partnership with internal teams. • Develop and maintain workflows and documentation: Design, implement, and regularly update standardized workflows, procedures, and timelines to support consistent practices, operational readiness, and data integrity throughout the full provider lifecycle. • Ensure clear operational handoffs across departments and adherence to established timelines for onboarding and offboarding activities. • Collaborate with Network Training and Compliance teams: Partner with the Network Training Specialist for all education and training needs, and work with the Compliance team to confirm all policies, desktop procedures, and materials associated to provider onboarding and offboarding comply with regulatory and organizational standards. • Monitor project milestones and risk management: Track and analyze project deliverables, identify risks or process gaps, and coordinate timely resolutions with business partners to maintain accuracy and efficiency across operational readiness for provider onboarding and offboarding. • Serve as subject matter expert and liaison: Represent Network Management in cross-functional meetings and governance committees related to provider onboarding and offboarding, providing insight and expertise on provider implementation, configuration readiness, and operational optimization. • Ensure regulatory and audit readiness: Promote compliance and adherence to CMS, DMHC, DHCS, and NCQA requirements through accurate documentation, lifecycle tracking, and post-termination data closure activities to maintain audit preparedness and meet quality standards. • Facilitate provider communications, education, and presentations: Collaborate with Network Training and Communications teams to enhance provider onboarding materials, orientation tools, and outreach initiatives enhancing provider understanding and engagement. • Conduct provider presentations and engage directly with provider partners to ensure clarity around onboarding expectations, operational workflows, and ongoing requirements. • Drive continuous process improvement: Identify and implement enhancements to workflows, tools, templates, and reporting processes that increase efficiency, accuracy, and provider satisfaction throughout the lifecycle. • Support system modernization and integration efforts: Contribute to SCAN’s system improvement and migration projects by capturing business requirements, testing enhancements, validating changes, and supporting implementation during and after release.

• Managing Concierge Teams in the delivery of effective and efficient Member resolutions in pursuit of Member Satisfaction. • Managing multiple Concierge Teams and their assigned PMG Groups. • Maintaining business continuity through workforce management and contingency planning, including acting as back-up for Concierge staffing needs. • Monitoring and managing call volumes to flex staffing needs in case of call surges. • Providing oversight to ensure customer service standards are achieved including response times, productivity, and call quality. • Analyzing data and trends received from Concierge to determine service gaps and deliver feedback to Concierge and internal departments. • Participating in the interviewing, training, auditing, coaching and providing feedback to staff. • Providing personal growth opportunities for Concierge team. • Following all appropriate Federal and State regulatory requirements and guidelines applicable to SCAN Health Plan operations. • Resolving escalated member issues and maintaining contacts and relationships within SCAN and with PMG partners.

• Responsible for developing and implementing a quality assurance program, reviewing audits meet accuracy, timeless and contractual obligations, and enhancing operational processes. • Partner with Ops leadership to design and develop an effective Quality Assurance and Compliance program gaining alignment on methodology, audit approach, KPIs, standards and issue resolution process • Manage quality and Compliance reporting. • Coordinate accurate and timely submission of data, including audit readiness and documentation standards for Operations • Collaborate with operational partners to align workflows, address barriers to performance, and implement initiatives to enhance operations and member satisfaction. • Monitor and communicate performance trends track and analyze key performance indicators (KPIs). • Share actionable insights and recommendations with senior leadership to inform strategic planning and resource allocation. • Establish effective governance framework to include Audit the Auditor mechanism to achieve organizational goals related to quality and compliance. • Lead a team of quality assurance and compliance professionals mentoring, fostering positive team culture, promote leadership growth, encourage innovation, and continuous learning to achieve team or individual goals • Identifying trend and areas of opportunity for process improvements and additional training • Work closely with operations leadership to review finding, develop action plans and remediate issues • Partner with operational leadership to review finding, develop corrective action plans, and remediate identified issues to the root cause ensuring a closed loop process • Monitor industry trends, regulatory changes and current events to ensure team remains informed and adapts to evolving policies and procedures. • Supervises/Manages Others (i.e. hires, performance reviews, corrective action, etc.) • Actively support the achievement of SCAN’s Vision and Goals.

• Building and maintaining effective provider relationships with medical groups and associated primary care physicians, specialists, hospitals, and ancillaries. • Drive strategic dialogue and planning with providers. • Manage the end-to-end operational interface with providers across all contractual fee types and risk arrangements. • Oversee executive escalation governance and resolve complex, cross-functional provider issues through structured project management. • Lead Joint Operating Committees (JOCs) and executive performance reviews with MSOs, IPAs, and medical groups.

• Monitor, analyze, and develop insights on STAR measure performance for HEDIS, CAHPS, HOS, Pharmacy (PQA), and Operational measures. • Perform root-cause analysis to identify drivers of performance gaps and recommend targeted interventions. • Partner with Health Care Informatics and other internal analytics team to ensure dashboards, scorecards, and routine performance reports for leadership and operational partners. • Model future projections and perform “What-if” scenarios for STAR rating forecasts. • Conduct routine process analysis for department’s operating procedures and validate compliance with regulatory requirements or develop details assessment outlining gaps/risks identified with proposed process redesigns to mitigate identified gaps and risks. • Collaborate with internal teams (Clinical Operations, Pharmacy, Member Experience, Network, Provider Relations) to design and implement quality improvement strategies. • Track performance of interventions and provide data-driven insights on progress and effectiveness. • Conduct Star competitor analysis and develop insights for all SCAN markets, potential partnerships, or growth opportunities. • Work with IT and data teams to enhance data infrastructure and ensure data quality for STAR reports, and troubleshoot data discrepancies. • Support the design and evaluation of interventions aimed at improving provider performance, member satisfaction, and clinical outcomes.

• Serve as a direct point of contact for members’ questions and concerns. • Responsible for taking member calls, as well as making proactive calls, as needed. • Liaison between the members and SCAN’s internal and external stakeholders. • Ensure that members’ issues/questions/concerns are being addressed across the entire SCAN internal and external value chain with timely and effective resolution. • Drive SCAN’s Concierge customer service philosophy and are critical to ensure members get their healthcare administrative issues/questions resolved in a timely fashion. • Assist the team leads, the Concierge and Associate Concierge, in managing their memberships as a book of business. • Serve primarily on an in-bound call queue resolving member’s questions as they call SCAN. • Following-up on pending member issues. • Performing research to resolve a member’s issue. • Performing proactive outreach to members. • Performing hand-offs amongst team members regarding resolving member issues. • Coordinating issue resolution between internal and external stakeholders. • Support the Concierge in owning and maintaining the relationship with internal and external stakeholders. • Document interactions with members to update member’s records and help track issue resolution.

• Analyze frontline performance and experience data to identify trends, pain points, and improvement opportunities. • Gather and synthesize Rebel (frontline) feedback through surveys, QA data, and voice-of-employee inputs. • Support frontline experience initiatives that improve day-to-day work conditions and service delivery. • Translate QA and performance insights into actionable recommendations for coaching and development. • Partner with HR and Operations to support career pathing and promotion readiness using data-driven insights. • Evaluate training and onboarding effectiveness and identify gaps aligned to role expectations. • Execute and support the Voice of Employee program, including reporting and action planning. • Coordinate cross-functional improvement projects impacting frontline experience and member.

• Provide long-term care management to frail, economically disadvantaged, culturally diverse older adults, disabled adults and caregivers in order to help them remain safely at home and to prevent premature institutionalization • Assess new clients and determine appropriateness for the MSSP program, certify the client as nursing home eligible, conduct assessments and reassessments for identification of client’s medical, physical, and psychological needs • Ensure client’s needs are met through written care plan approved by the program supervisor and discussed verbally with the client and/or his representative • Provide ongoing health education to non-clinical staff members • Present cases at and participates in weekly team case conference per guidelines • Discuss during case conference complex health care issues for teaching purposes • Contact client’s physician as needed to discuss health problems identified during assessments • Provide education to the client or family member regarding topics including self-care, hygiene, and nutrition • Collaborate with staff, clients, physicians, home health, community services, family members, hospital discharge planners, and other professionals involved in the care of the client to assure appropriate services, and safe living environment below the cost of a skilled nursing facility • Maintain monthly documentation of clients along with other clinical documentation of relevant contacts with clients, service providers, health professionals, or other community agencies in a timely manner • Maintain accurate purchase of service records by completing accurate and timely monthly service authorizations and verifications to contracted vendors and following contract guidelines for service expenditures • Develop and implement care plans for assigned caseload • Help to maintain census and provide excellent customer service in the community by participating in ongoing outreach activities • Participate regularly in Quality Assurance chart reviews, completing other audits as required, helping to train new employees, participating in training sessions, and responding positively to suggestions for improvement • Increase knowledge by keeping current on Medicare and Medi-Cal policies, Federal and State legislation affecting health and social services, maintaining updated community resource information, attending trainings as scheduled, actively participating in supervision, and striving to improve professionally • Other duties as assigned.

• Support program operations by answering incoming community calls and providing program eligibility information • Record information obtained from all interactions into electronic documentation • Perform intake functions that include conducting initial interviews, gathering pertinent information, assessing urgency of the need, and providing overall program information • Maintain member's right to privacy and protect SCAN operations by keeping information confidential • Inform the community and potential clients about IAH services utilizing approved presentation materials • Establish, develop and cultivate relationships in the communities IAH serves • Educate and communicate to external audiences about IAH