Senior Manager, Provider Operations

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

📋 Description

• Oversee the accuracy of provider data throughout the entire process, including roster intake, credentialing, validation, verification, exception handling, remediation, and subsequent directory publication.

• Act as the primary accountable owner for provider directory compliance, ensuring adherence to CMS Medicare Advantage accuracy and verification requirements, as well as online directory obligations.

• Keep audit-ready documentation and lead the organization’s responses to regulatory inquiries and audits.

• Direct, manage, and expand a hybrid team consisting of both onshore and offshore members through hiring, onboarding, training, quality assurance, capacity planning, and performance management.

• Enhance and operate a signal-driven accuracy infrastructure utilizing scoring and prioritized verification queues.

• Establish, measure, and report on provider data accuracy metrics and SLAs to executive stakeholders.

• Convert results into a prioritized strategic roadmap.

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

• Ensure the accuracy and completeness of data regarding specialty, panel status, accepting-new-patient indicators, location, and PCP assignment.

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

• Assess and manage vendors that support provider data and directory accuracy.

⛳️ Requirements

• Bachelor’s degree with a minimum of 6 years of relevant experience, including at least 2 years in a direct management role.

• Experience within a health plan or healthcare operations, with hands-on responsibility for provider data, provider directory, credentialing, or network operations.

• Familiarity with the regulatory landscape governing provider directories, including CMS Medicare Advantage directory and network adequacy requirements, and the ability to read and operationalize regulatory guidance.

• Skilled in analyzing data sets to derive insights and translate those insights into actionable outcomes.

• Proven track record of developing repeatable operational processes that yield measurable quality outcomes, including QA frameworks and documented workflows.

• Excellent communication skills to facilitate collaboration and influence stakeholders across compliance, network, product, and engineering domains.

• Outstanding organizational skills, capable of effectively prioritizing tasks to consistently meet deadlines.

• Experience in managing or scaling offshore and/or vendor delivery teams.

• Background in applying AI and automation to minimize manual operational tasks.

• Experienced in leading or supporting a regulatory audit or corrective action plan.

• Proficiency in SQL or similar tools to query and validate provider data directly.

• Thrives in a fast-paced, metrics-driven environment and is comfortable with uncertainty.

🏝️ Benefits

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

• Generous paid time off.

• $100 monthly stipend for mobile or internet expenses.

• Stock options available for all employees.

• Bonus eligibility for all roles, excluding Director-level positions and above.

• Parental leave program.

• 401K retirement program.

• Comprehensive total rewards package for full-time employees.