Sr. Manager Provider Operations

Job Description A bit about this role:
The Provider Operations team is responsible for delivering tight operations, meaningful data and analytics, user-friendly tools and content, and shared best practices across markets. Foundational to this strategy is our ability to be an engine of accurate provider data, which is inherently complex, messy, and ever-changing. Accurate and accessible provider data allows us to better serve our members and providers, reduces our administrative cost and burden, and keeps us compliant with a growing set of federal and state directory requirements.

This role owns provider data and directory accuracy end to end - from the validation and verification work that keeps our records current, to the compliance posture that makes our directory defensible in front of CMS, to the strategic question of how we turn the directory into a tool that actively navigates members to high quality, accessible care. The Sr.

Manager will lead a hybrid onshore and offshore team and is expected to grow that team as we scale. We’re looking for a leader who is equally comfortable in a regulation, a data set, and a room full of cross-functional stakeholders.

• Own provider data accuracy end to end - validation, verification, exception handling, and remediation across roster intake, credentialing, and downstream publication to our member-facing directory
• Serve as the accountable owner for provider directory compliance, including CMS Medicare Advantage directory accuracy and verification requirements, online directory obligations.
• Maintain audit-ready documentation and lead our response to regulatory inquiries and audits
• Lead, manage, and grow a hybrid onshore and offshore team - hiring, onboarding, training, quality assurance, capacity planning, and performance management - building the structure and documentation that let the team scale without a linear increase in headcount
• Operate and improve our signal-driven accuracy infrastructure, using scoring and prioritized verification queues to focus outreach where the risk to members and to compliance is highest
• Define, instrument, and report the metrics and SLAs for provider data accuracy; deliver clear, credible reporting to executive stakeholders and translate results into a prioritized roadmap
• Shape directory strategy - partner with product, engineering, and network leaders to evolve the directory from a compliance artifact into a care navigation tool that helps members find high quality, accessible providers
• Support care navigation initiatives by ensuring the underlying data that drives steerage decisions is accurate and complete, including specialty, panel status, accepting-new-patient indicators, location, and PCP assignment
• Partner with product and engineering to automate manual validation work, and evaluate and manage vendor relationships supporting provider data and directory accuracy

• Bachelor’s degree and a minimum of 6 years of relevant experience, including at least 2 years directly managing a team
• Experience at a health plan or in healthcare operations, with hands-on ownership of provider data, provider directory, credentialing, or network operations
• Working knowledge of the regulatory environment governing provider directories - CMS Medicare Advantage directory and network adequacy requirements, and comfort reading and operationalizing regulatory guidance
• Proficient in analyzing data sets to generate insights and turn those insights into action
• Demonstrated success building repeatable operational processes with measurable quality outcomes, including QA frameworks and documented workflows
• Strong communication skills to facilitate collaboration and influence stakeholders across compliance, network, product, and engineering
• Exceptional organizational skills, adept at prioritizing tasks effectively to consistently meet deadlines

• Experience managing or scaling offshore and/or vendor delivery teams
• Experience applying AI and automation to reduce manual operational work
• Experience leading or supporting a regulatory audit or corrective action plan
• SQL or equivalent…