Senior Manager, Provider Operations

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

📋 Description

• Take full ownership of the accuracy of provider data throughout the entire process, including roster intake, credentialing, downstream publication, validation, verification, exception management, and remediation.

• Act as the accountable owner for compliance with provider directory regulations, encompassing CMS Medicare Advantage requirements and obligations for online directories.

• Maintain documentation that is audit-ready and lead responses to regulatory inquiries and audits.

• Lead, manage, and develop a hybrid team consisting of both onshore and offshore members, which includes hiring, onboarding, training, quality assurance, capacity planning, and performance management.

• Enhance the infrastructure for signal-driven accuracy by utilizing scoring systems and prioritized verification queues.

• Define, measure, and report on provider data accuracy metrics and service level agreements (SLAs) to executive stakeholders.

• Collaborate with product, engineering, and network leaders to shape the directory strategy that supports care navigation.

• Ensure the accuracy and completeness of data concerning specialty, panel status, accepting-new-patient indicators, location, and primary care provider assignments.

• Work closely with product and engineering teams to automate manual validation processes.

• Assess and manage vendors that assist with provider data and directory accuracy.

⛳️ Requirements

• A bachelor’s degree.

• A minimum of 6 years of relevant experience.

• At least 2 years of direct team management experience.

• Experience working at a health plan or in healthcare operations.

• Hands-on experience with provider data, provider directories, credentialing, or network operations.

• Familiarity with provider-directory regulations, including CMS Medicare Advantage directory and network adequacy requirements.

• Proficient in analyzing data sets and converting insights into actionable steps.

• Proven success in building repeatable operational processes with measurable quality outcomes, including quality assurance frameworks and documented workflows.

• Strong communication abilities for effective cross-functional collaboration and stakeholder influence.

• Outstanding organizational skills and the capacity to prioritize tasks while consistently meeting deadlines.

🏝️ Benefits

• Employer-sponsored health, dental, and vision plans with low or no premium costs.

• Generous paid time off policies.

• A monthly stipend of $100 for mobile or internet expenses.

• Stock options available to all employees.

• Bonus eligibility for all roles except those at the Director level and above.

• 401K retirement savings program.

• Parental leave program.