Senior Manager, Provider Operations

🔥 5 minutes ago

🇺🇸 United States – Remote

💵 $110.5k - $151k / year

⏰ Full Time

🟠 Senior

⚙️ Operations

👻 Ghost score 0%

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Devoted Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2017

🏥 Healthcare

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare • Healthcare Insurance • Wellness

Devoted Health is a healthcare company that offers Medicare Advantage plans designed to provide comprehensive health coverage with added benefits like dental, eyewear, gym memberships, and prescription drugs at competitive rates. The company emphasizes member support and service, ensuring that clients can easily navigate their benefits and access needed healthcare services. Devoted Health is committed to helping customers save money and enhance their health and wellness through a complete package of benefits and support.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• 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