Director, Provider Network Operations

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

📋 Description

• Responsible for the core operational, data, and systems functions of the Provider Network department.

• Supervise divisions such as Provider Relations, Provider Data Management, Credentialing, and provider platform interoperability.

• Lead planning and execution initiatives both within the department and across different departments.

• Steer strategic projects related to network establishment and maintenance, provider data accuracy, education, service, contract implementation, claims, audits, corrective action plans, and directory precision.

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

• Direct the Credentialing division to ensure compliance and operational excellence.

• Create strategies for provider education and relationship management.

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

• Work with software vendors and internal stakeholders to improve interoperability and streamline processes.

• Collaborate with IT and operational leaders to identify and resolve interoperability issues.

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

• Develop automated processes for accurate 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 on processes, technology, and staffing resources.

• Oversee provider collaborations with various departments and leaders.

• Assist functional leaders in creating business plans.

• Design and implement provider education programs.

• Evaluate provider feedback and initiate relationship enhancements.

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

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

• Implement coaching and training programs in collaboration with division leaders.

• Oversee resource prioritization as new competencies emerge.

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

• Provide ongoing feedback and hold one-on-one meetings with direct reports.

• Foster employee engagement through educational programs and cultural initiatives.

• Manage division budgets and expenditures, taking corrective measures as necessary.

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

• Evaluate innovative provider payment methodologies for approval and implementation.

• Adhere to privacy policies and HIPAA confidentiality and security standards.

• Perform additional duties as assigned.

⛳️ Requirements

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

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

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

• In-depth knowledge of provider reimbursement methodologies, provider network operations, compliance standards, and healthcare data management is essential.

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

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

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

• Ability to formulate and implement strategic initiatives.

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

• Capability to lead teams within a matrixed organizational structure and cultivate high-performing teams.

• Proven experience in collaborative interactions with provider leaders.

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

• Communicate clearly and effectively.

• Willingness to travel approximately 15% of the time.

• Ability to stoop and bend.

• Capacity to sit and/or stand for extended periods while performing essential job functions.

• Engage in repetitive tasks including typing, sorting, and filing.

• Capable of light lifting and carrying of files and business materials.

🏝️ 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.

• Opportunities for personal growth and career advancement.

• Learning, development, and career progression opportunities.

• Work-life balance.

• Individual development and career advancement opportunities.