The JobThe Director, Provider Data Operations ensures provider information is accurate, complete, timely, governed, and trusted across the enterprise. This role is responsible for the evolution of a single source of truth for provider data and enables downstream operational, regulatory, network, member-facing, and provider-facing processes with reliable provider intelligence. The Director will work cross functionally driving continuous improvement, AI-enabled automation, data quality controls, and governance practices that strengthen provider data accuracy, reduce manual effort, improve workflow efficiency, and increase confidence in internal and external provider directories.
You Will Leads end-to-end provider data operations, including provider hierarchy, provider records, verification, roster management, reconciliation, delegated oversight, audit readiness, issue resolution, and continuous improvement.
Owns provider data accuracy and directory integrity by establishing quality standards, validation controls, audit processes, and root-cause resolution to prevent recurring data defects. Responsible for data accuracy on internal and external provider directories.
Drives strategy and governance for provider data as a trusted enterprise source of truth, including policies, procedures, business rules, data stewardship, and alignment with downstream systems and workflows. Contributes to planning, direction, and goal setting for the department or function in collaboration with senior management.
Ensures regulatory and business readiness by maintaining controls that support CMS and state requirements, network adequacy, provider directory accuracy, product participation, provider terminations, and delegated oversight.
Understands and implement new and future compliance requirements. Supports critical business strategies by providing systematic solutions and/or recommendations on business processes. Proficient in navigating legislative changes, federal and state regulations, to direct teams to make necessary changes.
Directs small and medium projects and initiatives. Define and deliver initiatives according to agreed-upon business requirements and timelines.
Partners across Operations, Technology, Network Management, Compliance, Product, Digital, vendors, and delegated provider groups to integrate, govern, and improve provider data across enterprise processes.
Leads implementation, optimization, and oversight of provider data applications, vendor solutions, automation, and AI-enabled capabilities that improve accuracy, efficiency, workflow performance, and decision-making.
Monitors performance against KPIs, SLAs, quality measures, and risk indicators; translate trends into actionable insights, recommendations, and operational action plans. Proactively identifies opportunities for process improvements.
Establishes departmental policies, practices, and procedures that have a significant impact on the organization. Oversee the creation of document workflows and policies and procedures (P&Ps) as necessary.
Builds and develop a high-performing team by setting clear goals, accountability standards, training expectations, and a culture of service, innovation, continuous improvement, and data stewardship.
Establishes staffing needs and ensure consistent training for staff through adoption of standardized processes.
We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.
Actively support the achievement of SCAN's Vision and Goals.
Other duties as assigned.
Your QualificationsBachelor's Degree or 5+ years equivalent work experience;
2+ years of leadership experience
2+ years in leading Provider Data Management teams at managed care provider organization (IPA, Medical Group or institutional provider) or insurance company
5+ years of overall Healthcare experience.
What's in it for you?- Base Pay Range: $147,900-$205,000, Salary
- Work Mode: Remote
- An annual employee bonus program
- Robust Wellness Program
- Generous paid-time-off (PTO)
- 11 paid holidays per year, 1 floating holiday, birthday off, and 2 volunteer days
- Excellent 401(k) Retirement Saving Plan with employer match
- Robust employee recognition program
- Tuition reimbursement
- An opportunity to become part of a team that makes a difference to our members and our community every day!
We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!
At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.
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