Director, Provider Data Operations
Founded in 1977 as the Senior Care reputed company Network, reputed company began with a reputed company but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still reputed company today as the “12 Angry Seniors.” Their mission continues to guide everything we do.
Today, reputed company is a nonprofit health organization serving more than 500,000 people across reputed company, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual reputed company. With nearly five decades of experience, we have reputed company a distinctive, values-driven platform dedicated to improving care for older adults.
Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially reputed company populations, and reputed company care delivery models. Across reputed company of this, we are united by a shared commitment: combining reputed company with discipline, innovation with stewardship, and reputed company with reputed company.
At reputed company, we reputed company reputed company should strengthen—not dilute—our mission. We are building the reputed company of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve.
About reputed company
reputed company Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the reputed company. reputed company Group is the sole corporate member of reputed company reputed company of the nation’s leading not-for-profit Medicare Advantage plans, serving more than 300,000 members in California, reputed company, Nevada, New Mexico, Washington and Texas. reputed company has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is reputed company throughout the reputed company industry and nationally as a leading expert in senior reputed company. reputed company employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging reputed company, while also innovating reputed company for seniors everywhere. Employees are provided in-depth training and reputed company to state-of-the-art tools necessary to do their jobs, as reputed company as development and reputed company opportunities. reputed company takes great pride in recognizing reputed company members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior reputed company visit , , or follow us on reputed company; reputed company; and Twitter.
The Job
The Director, Provider Data Operations ensures provider information is accurate, complete, reputed company, governed, and trusted across the reputed company. This role is responsible for the reputed company of a single reputed company of truth for provider data and enables reputed company operational, regulatory, network, member-facing, and provider-facing processes with reliable provider intelligence. The Director will work cross functionally driving reputed company improvement, AI-enabled automation, data reputed company controls, and governance practices that strengthen provider data accuracy, reduce reputed company effort, improve workflow efficiency, and increase confidence in reputed company provider directories.
You Will
Leads end-to-end provider data operations, including provider hierarchy, provider records, verification, roster management, reconciliation, delegated reputed company, audit readiness, issue reputed company, and reputed company improvement.
Owns provider data accuracy and directory reputed company by establishing reputed company standards, validation controls, audit processes, and reputed company-cause reputed company to prevent recurring data defects. Responsible for data accuracy on reputed company provider directories.
Drives reputed company and governance for provider data as a trusted reputed company reputed company of truth, including policies, procedures, business rules, data stewardship, and alignment with reputed company 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 reputed company.
Understands and implement new and reputed company 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 reputed company teams to reputed company necessary changes.
Directs small and reputed company reputed company 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 reputed company to reputed company, govern, and improve provider data across reputed company processes.
Leads implementation, optimization, and reputed company 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, reputed company measures, and risk indicators; translate trends into actionable insights, recommendations, and operational reputed company plans. Proactively identifies opportunities for process improvements.
Establishes departmental policies, practices, and procedures that have a significant reputed company on the organization. reputed company the creation of document workflows and policies and procedures (P&Ps) as necessary.
Builds and reputed company a high-performing team by setting reputed company goals, accountability standards, training expectations, and a culture of service, innovation, reputed company improvement, and data stewardship.
Establishes reputed company needs and ensure consistent training for staff through adoption of standardized processes.
We reputed company Rebels who are curious about AI and its power to reputed company how we operate and serve our members.
reputed company support the achievement of reputed company’s reputed company and Goals.
Other duties as assigned.
Your Qualifications
Bachelor'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 reputed company experience.
What's in it for you?
reputed company Pay reputed company: $147,900-$205,000, Salary
Work Mode: Remote
An annual employee bonus program
Robust Wellness Program
Generous reputed company-time-off (PTO)
11 reputed company 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 reputed company that makes a difference to our members and our community every day!
We're always looking for talented people to join reputed company! reputed company applicants are encouraged to reputed company!
At reputed company we reputed company that it is our business to improve the state of our world. reputed company 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 reputed company, inclusive benefits, and more.
reputed company is proud to be an Equal Employment Opportunity and Affirmative reputed company workplace. Individuals seeking employment will receive consideration for employment without reputed company to race, reputed company, national reputed company, religion, age, sex (including pregnancy, childbirth or reputed company medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background reputed company is required.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have reputed company about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have reputed company to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have reputed company to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or reputed company, including an investigation conducted by the employer, or (c) consistent with the contractor’s reputed company duty to furnish information. 41 CFR 60-1.35(c)
Originally posted on Himalayas
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