The Provider Lifecycle Director - Transformation is responsible for defining and executing the strategy to improve provider operations across the health plan. This role leads initiatives that improve operational performance, strengthen compliance, reduce administrative costs, and support growth.

The Director partners across Provider Operations, Network Management, Clinical Operations, Technology, Analytics, Compliance, Finance, and market leadership to redesign processes, implement technology solutions, and establish scalable operating models.

This role is accountable for transformation initiatives across Claims Operations, Credentialing, Provider Data Management, Prior Authorization, Provider Services, Delegation Oversight, and Contract Administration. Responsibilities include process redesign, technology enablement, operating model improvements, and delivery of measurable business outcomes.

Provider Operations Strategy & Transformation

• Define and execute a multi-year strategy to improve provider operations.
• Establish and manage a portfolio of transformation initiatives across provider functions.
• Identify opportunities to improve efficiency, scalability, compliance, accuracy, and provider experience.
• Develop business cases, investment plans, and success measures.

Operating Model Design

• Design and implement operating models across provider operations functions.
• Develop workflows, governance structures, service models, and accountability frameworks.
• Simplify processes, eliminate redundancies, and improve cross-functional coordination.
• Establish sustainable operating practices that support long-term business objectives.

Process Improvement

• Lead process redesign initiatives across Claims, Credentialing, Provider Data Management, Prior Authorization, Contracting, Delegation Oversight, and Provider Services.
• Identify root causes of operational inefficiencies, provider friction, quality issues, and compliance risks.
• Apply process improvement methodologies, automation, and industry best practices.
• Standardize workflows and operating procedures where appropriate.

Technology & Digital Enablement

• Partner with Product, Technology, and Operations teams to define provider operations technology priorities.
• Translate business requirements into scalable technology solutions.
• Lead implementation of automation, AI-enabled capabilities, digital intake solutions, provider portals, and workflow platforms.
• Ensure technology investments improve productivity, accuracy, and turnaround times.

Performance & Operational Outcomes

• Establish KPIs and performance measures for transformation initiatives.
• Monitor results and ensure initiatives deliver measurable business value and return on investment.
• Develop executive reporting and dashboards.
• Drive accountability for operational improvements.

Leadership & Governance

• Serve as the primary liaison across Provider Operations, Network Management, Clinical Operations, Technology, Analytics, Compliance, Finance, and market leadership.
• Facilitate executive governance forums and steering committees.
• Build stakeholder alignment and drive adoption of new processes, operating models, and technologies.
• Influence leaders across the organization to achieve transformation goals.

Supervisory Responsibilities:

This role is an individual contributor.

Job Requirements:

Experience:
Required:

• Minimum 8 years of experience in healthcare operations, business transformation, operational excellence, consulting, or related functions.
• Minimum 5 years leading large-scale cross-functional transformation initiatives.
• Experience redesigning operational processes and implementing operating model improvements that delivered measurable results.
• Experience leading complex initiatives involving multiple functions and executive stakeholders.
• Experience developing business cases, transformation roadmaps, performance frameworks, and executive presentations.
• Experience managing initiatives involving technology, operations, and organizational change.

Preferred:

• Medicare Advantage experience.
• Experience leading transformation, process improvement, or operational excellence functions.
• Consulting experience supporting healthcare transformation.
• Experience implementing AI, automation, digital transformation, or workflow technologies.
• Experience supporting rapid growth and operational scaling.

Education:

Required:

• Bachelor's degree in Healthcare Administration, Business Administration, or a related field; four years of additional directly related experience may substitute for a degree.

Preferred:

• MBA, MHA, or equivalent graduate degree.
• Training in Lean, Six Sigma, Agile, Project Management, Human-Centered Design, or Change Management.
• Relevant certification in process improvement, project management, or transformation methodologies.

Training:

Required:

• Knowledge of healthcare delivery models, provider performance management, referral management, care routing, and value-based care principles.

Preferred:

• Training in product management, digital transformation, change management, or healthcare operations leadership.
• Lean, Six Sigma, or other process improvement methodologies.

Specialized Skills:

Required:

• Provider Operations Strategy & Transformation (Advanced): Ability to develop and execute strategies that improve provider operations, performance, scalability, compliance, and provider experience.
• Operating Model Design (Advanced): Ability to design scalable operating models, workflows, governance structures, and service delivery frameworks.
• Business Process Improvement (Advanced): Ability to evaluate complex operational processes, identify root causes, and implement solutions that improve efficiency, quality, and performance.
• Digital Transformation & Technology Enablement (Advanced): Ability to prioritize technology investments and implement solutions that improve operational performance and workforce productivity.
• Data Analytics & Performance Management (Advanced): Ability to establish KPIs, assess performance, identify improvement opportunities, and translate data into actionable recommendations.
• Organizational Change Management (Advanced): Ability to lead large-scale change initiatives and drive adoption of new processes, technologies, and operating models.
• Cross-Functional Leadership & Influence (Advanced): Ability to align stakeholders across Operations, Clinical Services, Technology, Analytics, Compliance, Finance, and business leadership teams.
• Strategic Planning & Execution (Advanced): Ability to develop long-term plans, prioritize investments, establish governance, and deliver measurable business outcomes.
• Executive Communication & Stakeholder Management (Advanced): Ability to develop executive presentations, business cases, operating reviews, and recommendations for senior leadership.

Pay Range: $130,332.00 - $195,498.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.