Director, Provider Network Operations

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

📋 Description

• Supervise the Provider Network divisions, including Provider Relations, Provider Data Management, Credentialing, and provider platform interoperability.

• Direct specific departmental and inter-departmental planning and execution to uphold Provider Network and enterprise KPIs.

• Steer strategic initiatives for network establishment and maintenance, ensure provider data integrity, facilitate provider education and service, manage contract implementation, oversee provider-related claims, provider setup and audits, and maintain provider directory accuracy.

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

• Create and implement objectives for the Credentialing division while guaranteeing compliance and operational excellence.

• Formulate strategies for provider education and relationship management to enhance provider collaboration, engagement, and satisfaction.

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

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

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

• Develop automated workflows to ensure accurate data synchronization across platforms and departments.

• Enhance functionality through 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 stewardship targets.

• Oversee provider collaborative efforts and division business plans.

• Design and implement provider education programs while assessing provider feedback.

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

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

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

• Recruit, mentor, coach, and conduct performance evaluations for staff and direct reports.

• Foster employee engagement within the Provider Network.

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

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

• Evaluate new provider payment methodologies for approval and implementation.

• Meet departmental and company performance and attendance expectations.

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

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

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

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

• 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, alongside the required minimum years of work experience, will also be considered.

• Ability to develop and implement strategy.

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

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

• Demonstrated collaborative interaction experience with provider leaders.

• Accountable leadership, strong business and financial acumen, empowerment, influential communication, situational leadership, and strategic planning skills.

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

• Ability to communicate clearly and effectively.

• Capacity to stoop and bend, sit and/or stand for extended periods, perform repetitive motions, and engage in light lifting and carrying.

• Must adhere to privacy policy and HIPAA laws and regulations regarding the confidentiality and security of protected health information.

🏝️ Benefits

• Travel is required approximately 15% of the time.

• Commitment to equal opportunity employment.

• Employee engagement, education, and cultural enhancement programs.

• Coaching and training programs.

• General office environment with ergonomically configured equipment.