Director, Provider Network Operations

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

📋 Description

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

• Drive strategic initiatives related to network establishment and upkeep, provider data accuracy, provider education and service, contract execution, provider-related claims, audits, corrective action plans, and directory precision.

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

• Lead the Credentialing division's efforts to ensure compliance and operational excellence.

• Create strategies for provider education, relationship management, collaboration, engagement, and overall satisfaction.

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

• Work in partnership with software vendors, IT teams, operational leaders, and internal stakeholders to enhance interoperability and optimize operations.

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

• Develop automated workflows and enhance functionality utilizing LEAN methodologies.

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

• Collaborate with executive leadership on processes, technology, human resources, performance metrics, and efficiency targets.

• Supervise provider collaborative efforts and assist functional leaders in formulating business plans.

• Design and implement provider education programs while addressing feedback from providers.

• Work closely 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; oversee resource prioritization and competency enhancement.

• Recruit, develop, mentor, and assess staff while fostering employee engagement.

• Oversee division budgets and expenditures, taking corrective actions when necessary.

• Evaluate innovative provider payment methodologies for approval and implementation.

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

• Adhere to privacy policies and HIPAA regulations; perform additional assigned duties.

⛳️ Requirements

• At least 8 years of experience in a leadership position managing healthcare provider network operations or related functions.

• Strong preference for candidates with experience 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.

• Knowledgeable about provider reimbursement methodologies, provider network operations, compliance requirements, and healthcare data management.

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

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

• Consideration will also be given to 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.

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

• Capable of leading individuals within a matrixed organizational structure and building high-performing teams.

• Proven ability to collaborate effectively with provider leaders.

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

• Ability to communicate clearly and effectively.

• Capable of stooping, bending, sitting or standing for extended periods, performing repetitive motions, and lightly lifting and carrying files and business materials.

🏝️ Benefits

• Equal opportunity employment.

• Travel approximately 15% of the time.

• General office environment with ergonomically configured equipment.

• At-will employment.