Director, Network Operations (14)

Director, Network Operations

This is a senior, AI-forward leadership role responsible for transforming and scaling provider data management and network operations within a complex healthcare environment.The Director, Network Operations will define the strategic roadmap for provider dataecosystems, credentialing systems, and network adequacy frameworks, ensuring data integrity, regulatory compliance, and operational excellence at scale.You will serve as the enterprise authority on Provider Data Management, driving automation, AI adoption, and modernization of highly critical operational workflows.

The role requires close collaboration with clinical leadership, compliance teams, external vendors, and internal data and technology functions to ensure a seamless, accurate, and compliant provider network experience.You will also oversee third-party credentialing partners and BPaaS vendors while ensuring performance accountability and operational alignment.This is a highly visible leadership position where your work directly impacts provider experience, regulatory compliance, and member access to care.

Accountabilities:

• Own the end-to-end strategy, architecture, and execution of the Provider Data Management (PDM) ecosystem, including ingestion of multi-source data feeds (e.g., NPPES, CAQH, provider rosters) into scalable data platforms.
• Ensure accuracy, integrity, and CMS-compliant publication of provider directories, implementing robust controls to minimize discrepancies and maintain regulatory alignment.
• Lead enterprise credentialing operations in partnership with clinical leadership, ensuring seamless execution of Credentialing Committee processes and regulatory compliance (including NCQA standards).
• Oversee third-party credentialing vendors and BPaaS partners, establishing performance metrics, enforcing SLAs, and ensuring operational excellence across external workflows.
• Drive AI and automation initiatives, including the use of LLMs and advanced data tools to automate provider data updates, validation, and anomaly detection.
• Lead and scale a fully remote network operations team, fostering a culture of accountability, precision, and data-driven execution.
• Act as the primary escalation and decision-maker for complex operational issues across Clinical, Compliance, Product, Claims, and Technology teams.
• Define and execute a long-term vision for network operations modernization, including development of a provider "Golden Record" and automated data governance frameworks.
• Continuously improve provider directory accuracy through auditing, monitoring, and systematic process optimization.
• Serve as a strategic partner to executive leadership, enabling faster decision-making through trusted, high-quality operational data.

Requirements:

• 8+ years of senior leadership experience in healthcare network operations, provider data management (PDM), or credentialing, ideally within Medicare Advantage environments.
• Deep subject matter expertise in Provider Data Management systems, including building or scaling automated data ecosystems and provider "golden record" frameworks.
• Strong understanding of CMS network adequacy requirements, provider directory compliance rules, and NCQA credentialing standards.
• Proven experience managing and holding third-party vendors, credentialing partners, or BPaaS providers accountable to SLAs and performance metrics.
• Demonstrated success implementing AI, automation, or advanced analytics to improve operational workflows and reduce manual processes.
• Strong leadership experience managing and scaling remote or distributed teams in complex operational environments.
• Excellent cross-functional influence skills, with the ability to align clinical, technical, compliance, and operational stakeholders.
• Strong analytical and data-driven mindset, with experience using dashboards and metrics to guide strategic decisions.
• Exceptional communication and executive presence, with the ability to translate complex systems into clear operational strategy.
• Highly adaptable, decisive, and comfortable operating in fast-paced, high-stakes healthcare environments.

Benefits:

• Competitive base salary aligned with senior leadership benchmarks
• Performance-based bonus and equity opportunities
• Comprehensive medical, dental, and vision insurance
• Remote-first work environment with flexible scheduling
• Generous paid time off and company holidays
• Paid parental leave and family support benefits
• 401(k) retirement plan with employer contributions
• Mental health support and employee wellness programs
• Learning, development, and leadership growth opportunities
• Access to advanced AI and data tooling in a cutting-edge healthcare technology environment.