Director, Provider Network Operations

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Lead strategic initiatives for Provider Network Operations, encompassing network establishment and upkeep, provider data accuracy, provider education and support, contract execution, provider-related claims, provider setup and audits, corrective action plans, and provider directory precision.

• Collaborate with the Provider Reimbursement Insights and Analytics Team to achieve objectives.

• Develop, guide, and implement Credentialing division goals while ensuring compliance and operational excellence.

• Create and implement strategies for provider education and relationship management.

• Direct the integration and continual operational efficiency of provider network platforms with legacy and emerging systems.

• Work with software vendors and internal stakeholders to enhance tool interoperability and streamline network operations.

• Partner with IT teams and operational leaders to pinpoint interoperability gaps and devise solutions.

• Ensure that integrated systems comply with state, federal, NCQA standards, and organizational policies.

• Create automated workflows and processes for accurate data synchronization across platforms and departments.

• Enhance functionality using LEAN methodologies and resources.

• Engage in strategic planning, execution, resource allocation, and performance monitoring.

• Collaborate with executive leadership to align processes, technology, and human resources with performance and efficiency goals.

• Supervise provider collaboration with other departments and leaders.

• Guide functional leaders in formulating business plans.

• Develop and deliver provider education programs regarding network policies, reimbursement processes, and regulatory requirements.

• Evaluate provider feedback and implement improvements in relationships.

• Collaborate with Operations, IT, Health Services, Analytics, Finance, and other departments.

• Oversee annual IT work plans, initiative work plans, financial budgets, and resource requirements.

• Create and implement coaching and training programs with division leaders.

• Manage resources and prioritization as new competencies emerge.

• Recruit, develop, mentor, and conduct performance evaluations for staff.

• Provide feedback, hold regular one-on-one meetings, and conduct performance reviews for direct reports.

• Foster employee engagement within Provider Network through educational programs and cultural initiatives.

• Manage division budgets and expenditures; monitor budget variances and implement corrective actions.

• Participate in Manager/Supervisor meetings, PRISM walks, internal committees, and departmental activities.

• Evaluate new provider payment methodologies for approval and implementation.

• Meet departmental and company performance and attendance standards.

• Perform additional duties as assigned.

⛳️ Requirements

• A minimum of 8 years of experience in a leadership position managing healthcare provider network operations or related functions is required.

• Experience leading at least two of the following areas: Provider Relations, Credentialing, and Provider Data Management is strongly preferred.

• Proven experience managing large, multi-tiered teams and complex operational portfolios.

• Required knowledge of provider reimbursement methodologies, provider network operations, compliance standards, and healthcare data management.

• Experience in developing and executing strategy within a matrixed organization is preferred.

• A Bachelor’s degree in business, health care administration, finance, or a related field is required.

• Candidates with an associate’s degree and 2 years of relevant experience, or a high school diploma and 4 years of relevant experience, in addition to the required minimum years of work experience will also be considered.

• Ability to formulate and execute strategy.

• Advanced understanding of provider reimbursement and related methodologies, provider relations, or provider partnership activities in relevant markets and geography.

• Capacity to lead teams within a matrixed organizational structure and build high-performing teams.

• Proven experience in collaborative interactions with provider leaders.

• Ability to read and understand both written and spoken English.

• Communicate clearly and effectively.

• Travel is required approximately 15% of the time.

• Must be able to stoop and bend.

• Ability to sit and/or stand for extended periods while performing core job functions.

• Involves repetitive motions including typing, sorting, and filing.

• Light lifting and carrying of files and business materials.

• Must adhere to privacy policies and HIPAA regulations concerning the confidentiality and security of protected health information.

🏝️ Benefits

• Flexible telecommute policy.

• Medical, vision, and dental insurance.

• Incentive program.

• Paid time off and holidays.

• 401(k) plan.

• Volunteer opportunities.

• Tuition reimbursement and training.

• Life insurance.

• Flexible spending account option.

• Opportunities for personal growth and advancement.

• Learning, development, and career advancement opportunities.

• Work-life balance.

• Individual development and career advancement support.