Senior Manager, Provider Operations

🕒 Setembro 24

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $110.500 - $151.000 / ano

⏰ Tempo Integral

🟠 Sênior

⚙️ Operações

👻 Score fantasma 12%

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Devoted Health

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 2017

🏥 Saúde

⚕️ Seguro de Saúde

🧘 Bem-estar

Healthcare • Healthcare Insurance • Wellness

A Devoted Health é uma empresa de saúde que oferece planos Medicare Advantage projetados para fornecer cobertura de saúde abrangente com benefícios adicionais como cuidados dentários, óculos, associações a academias e medicamentos prescritos a preços competitivos. A empresa enfatiza o suporte e serviço ao membro, garantindo que os clientes possam navegar facilmente por seus benefícios e acessar os serviços de saúde necessários. A Devoted Health está comprometida em ajudar os clientes a economizar dinheiro e melhorar sua saúde e bem-estar por meio de um pacote completo de benefícios e suporte.

Descrição

• Own provider data accuracy end to end across roster intake, credentialing, validation, verification, exception handling, remediation, and downstream directory publication • Serve as accountable owner for provider directory compliance, including CMS Medicare Advantage accuracy and verification requirements and online directory obligations • Maintain audit-ready documentation and lead responses to regulatory inquiries and audits • Lead, manage, and grow a hybrid onshore and offshore team through hiring, onboarding, training, quality assurance, capacity planning, and performance management • Operate and improve signal-driven accuracy infrastructure using scoring and prioritized verification queues • Define, instrument, and report provider data accuracy metrics and SLAs to executive stakeholders • Translate results into a prioritized roadmap • Shape directory strategy with product, engineering, and network leaders to support care navigation • Ensure accurate and complete data for specialty, panel status, accepting-new-patient indicators, location, and PCP assignment • Partner with product and engineering to automate manual validation work • Evaluate and manage vendors supporting provider data and directory accuracy

🎯 Requisitos

• 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 ability to query and validate provider data directly • Thrives in a fast paced, metrics driven environment and is comfortable with ambiguity

🏖️ Benefícios

• 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 • Parental leave program • 401K program • Total rewards package for full time employees

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