Director Provider Operations
Job Summary
The Director, Provider Operations builds, scales, and optimizes provider data management, contracting, and credentialing processes. This role is responsible for setting the vision and strategy for provider operations to improve capabilities in serving members and providers. The position involves cross-functional collaboration to take initiatives from vision to implementation.
Responsibilities
- Lead end-to-end provider data lifecycle and contracting processes
- Coach and manage a high-performing multi-tiered operations team
- Architect scalable data models and operational infrastructure
- Drive automation, efficiency, and regulatory compliance (NCQA/CMS)
- Collaborate cross-functionally to deliver strategic initiatives
Required Skills
- 10+ years operations/health insurance experience
- 5+ years leadership and team development
- Proficiency in provider data management and contracting
- Experience with process optimization and automation
- Strong data-driven decision-making and program management
Job Details
Responsibilities:
Strategic Leadership & Team Development
- Provide strategic leadership and operational oversight for the end-to-end provider data lifecycle, ensuring the precise and timely execution of provider credentialing, contract loading, and daily data management.
- Lead, coach, and develop a high-performing, multi-tiered team of managers and individual contributors; foster a culture of continuous learning, accountability, and psychological safety.
- Establish clear organizational structure, governance, and support systems that shield the team from distractions and empower them to execute key strategic initiatives.
- Act as a trusted, collaborative partner to Product, Tech, Markets, and Clinical Operations to design, build, and deliver next-generation provider operations capabilities.
Operational Excellence & Scalability
- Architect and implement foundational, industry-standard processes and data models that allow the provider data and contracting infrastructure to scale seamlessly.
- Champion the adoption of industry best practices to ensure all operational processes and internal tools are highly extensible, efficient, and integrated.
- Lead the team in surface-level and deep-dive diagnostics to identify data, process, and technology bottlenecks.
- Establish robust KPIs and monitoring dashboards to proactively flag operational issues.
Efficiency, Automation & Compliance
- Identify and execute opportunities for automation (e.g., RPA, AI integrations) to replace manual intervention, reduce turnaround times, and eliminate human error.
- Drive administrative expense savings and optimize total cost of care by identifying process improvements, technical tooling investments, and strategic vendor partnerships.
- Guarantee 100% compliance with all applicable state and federal laws, regulatory mandates (e.g., No Surprises Act, CMS requirements), and accreditation standards (NCQA).
Requirements:
- Bachelor's degree or 5+ years of operating experience.
- 10+ years of work in operations, health insurance, data analysis, and/or consulting.
- 5+ years of experience building, coaching, and developing operational teams.
- 5+ years experience with network operations, provider data management, and contracting processes.
- 5+ years successful experience developing and managing large-scale initiatives with internal and external stakeholders.
- 5+ years of experience designing and improving business processes for optimization.
- 5+ years of experience using data to influence business decisions.
- 5+ years of experience in program management.