Director of Network Operations

Job Summary

To lead the strategic roadmap for provider data management, the remote, full-time Director of Network Operations will oversee the accuracy and compliance of the consumer-facing Provider Directory, manage the end-to-end PDM Platform, and drive continuous improvement through advanced data integration and AI automation.

Key responsibilities

• Ensure the accuracy and regulatory compliance of the Provider Directory while implementing controls to minimize data discrepancies
• Lead the strategic oversight of third-party credentialing partners and establish performance metrics to align external workflows with internal goals
• Directly manage and mentor a remote network operations team, fostering a culture of accountability and technological fluency

Required qualifications

• 8+ years of executive leadership experience in healthcare network operations or provider data management, particularly within Medicare Advantage
• Deep expertise in Provider Data Management (PDM) and experience transforming data infrastructures into efficient automated systems
• Strong understanding of CMS network adequacy regulations and NCQA credentialing standards
• Proven experience managing third-party credentialing vendors and BPaaS partners to high performance standards
• Experience with AI and data solutions, including building automated data pipelines and architecting a PDM "Golden Record.