Director, Provider Network Operations

This is a fully remote position, open to applicants in United States.

📋 Description

• Manage the Provider Network divisions, which encompass Provider Relations, Provider Data Management, Credentialing, and interoperability of provider platforms.

• Direct strategic initiatives related to network establishment and maintenance, ensuring provider data integrity, provider education and service, contract execution, provider-related claims, provider audits, corrective action plans, and the accuracy of directories.

• Collaborate with teams focused on reimbursement insights and analytics to achieve set objectives.

• Formulate and implement strategies for Credentialing, provider education, and relationship management.

• Lead the integration and operational efficiency of provider network platforms with both legacy and emerging systems.

• Collaborate with software vendors, IT teams, and internal stakeholders to enhance interoperability and system compatibility.

• Ensure that integrated systems adhere to state, federal, NCQA, and organizational standards.

• Develop automated workflows to ensure precise data synchronization across platforms.

• Enhance functionality utilizing LEAN methodologies and resources.

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

• Collaborate with executive leadership to align processes, technology, and staffing with performance and efficiency targets.

• Oversee collaborative efforts among providers and guide division leaders in business planning.

• Design and implement provider education programs.

• Evaluate provider feedback and implement improvements in relationships.

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

• Create coaching and training programs while managing resource prioritization.

• Hire, develop, coach, and conduct performance evaluations for direct reports.

• Foster employee engagement within the Provider Network.

• Supervise division budgets and expenditures, implementing corrective measures as needed.

• Participate in manager/supervisor meetings, PRISM walks, internal committees, and department activities.

• Evaluate innovative provider payment methodologies.

• Adhere to privacy policies and HIPAA regulations, performing additional duties as assigned.

⛳️ Requirements

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

• Strong preference for experience in leading at least two of the following areas: Provider Relations, Credentialing, and Provider Data Management.

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

• Knowledge of provider reimbursement methodologies, provider network operations, compliance requirements, and healthcare data management.

• Preferred experience in developing and executing strategy within a matrixed organization.

• A Bachelor’s degree in business, healthcare 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, along with the required minimum years of work experience, will also be considered.

• Advanced knowledge of provider reimbursement and reimbursement methodologies, provider relations, or provider partnership activities.

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

• Demonstrated collaborative interaction experience with provider leaders.

• Proficient in reading and understanding both written and spoken English.

• Ability to communicate clearly and effectively.

• Capability to stoop and bend, sit and/or stand for extended periods, perform repetitive motions, and lift and carry files and business materials.

🏝️ Benefits

• Equal opportunity employment.

• Travel required approximately 15% of the time.

• Coaching and training programs.

• Employee engagement education/programs and cultural enhancements.

• At-will employment.