Job Description
A bit about this role:
On the Provider Operations team, we are responsible for credentialing the providers and facilities contracting with our health plan. We built our credentialing program from the ground up, and it credentials providers compliantly in industry-leading timeframes. That lets us build new networks quickly, show operational excellence to our providers, and keeps provider data current and accurate.
In our stage of growth, we are focused on implementing AI initiatives and expanding the responsibilities of our offshore team to make our operations faster, more efficient, and ready to scale. We’re looking for a Manager of Provider Operations who is a hands-on operator. You’ll be just as comfortable digging into work queues and untangling a messy case as you are redesigning a workflow or rethinking how a process could run with AI. Priorities will shift, and you’ll shift with them.
This is an ideal role for a results-driven leader who is mission driven, process oriented, data obsessed, and energized by change.
Your responsibilities and impact will include:
- Supporting day-to-day credentialing operations, including working queues yourself, unblocking complex cases, and driving best-in-class turnaround times and quality.
- Leading the effort to capture our operational knowledge in clear, usable SOPs and building a central documentation library that stays current as processes change.
- Helping manage and develop our offshore team, including training, documentation, and quality and productivity monitoring, with the goal of owning the offshore relationship over time.
- Partnering on offshore transitions by identifying work that can move offshore and supporting smooth handoffs without disrupting turnaround times or compliance.
- Assessing operational pain points and using data to size opportunities and build the business case for new solutions using data insights, including quantifying the impact of AI solutions, tech improvements, and offshore transitions before and after they launch.
- Creating and implementing AI solutions that make operations more efficient and enable scale, partnering with product and engineering where needed and testing, measuring, and refining what you build.
- Playing a key role in our 2027 CVO vendor transition, including workflow mapping, requirements, testing, and cutover, and helping monitor vendor performance once live.
- Becoming an expert in our internal systems and tools so you can troubleshoot issues and propose clear improvements to system logic.
- Owning key operational metrics, building reporting that surfaces trends and bottlenecks, and using data to guide decisions.
- Ensuring credentialing operations remain compliant with CMS, AAAHC, and state requirements as processes and tools evolve.
- Partnering cross-functionally with internal leadership, network and contracting teams, providers, vendors, and offshore partners.
Required skills and experience:
- 3-5+ years in operations, process improvement, or consulting.
- A true operator with a bias toward action. You’re willing to roll up your sleeves and do the work, not just direct it.
- A clear head for process. You’re passionate about efficiency and can predict and prevent bottlenecks before they happen.
- Comfort moving quickly between big-picture strategy and detailed, in-the-weeds execution.
- Ability to shift focus and reprioritize quickly in a fast-paced, evolving environment.
- You run toward complexity and have the stamina for hard problems.
- Detail-oriented, with a high bar for quality and accuracy.
- Ability and desire to understand and follow complex regulations.
- Strong communicator who can work with cross-functional stakeholders and drive alignment.
- Data, systems, and tech savvy, with the ability to build reporting that improves decision-making.
Desired skills and experience:
- Healthcare experience.
- Familiarity with credentialing standards and CMS requirements.
- Hands-on experience building and deploying AI tools to improve workflows, or a strong track record of applying technology and automation to operational problems.
- Experience with process improvement methodologies.
Salary Range: $73,000-$115,000/year
The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.
Our Total Rewards package includes:
Employer sponsored health, dental and vision plan with low or no premium
Generous paid time off
$100 monthly mobile or internet stipend
Stock options for all employees
Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
Parental leave program
401K program
And more....
*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.
