VP Network Operations

Job not on LinkedIn

🔥 1 minute ago

🗻 New Hampshire – Remote

🗻 New Hampshire – Remote

💵 $257.5k - $293k / year

⏰ Full Time

🔴 Lead

🌐 Network 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 the operational backbone of Devoted's provider network through provider data and performance decisions • Scale a performance management operation overseeing thousands of providers with automated, data-driven processes • Report to the SVP / Chief Network Officer and lead a team • Partner with Network Contracting, Engineering, Claims, Compliance, Finance, and Devoted Medical • Set the vision, roadmap, budget, staffing model, and vendor strategy for Network Operations • Build a high-performing team aligned with market expansion plans and annual CMS bid cycles • Ensure negotiated agreements are loaded and configured accurately for claims payment • Reduce contract-to-configuration cycle times and payment errors with Claims and Payment Integrity • Lead provider engagement and build a provider performance scorecard • Assist markets with providers’ financial review, unit cost analysis, and market trend interventions • Partner with Engineering and Product to automate high-volume workflows • Build KPIs and dashboards enabling Network Operations to scale without proportional headcount growth

🎯 Requirements

• 12+ years of health plan or managed care experience, including 7+ years leading provider network operations functions such as provider data management, contract configuration, credentialing, or provider service • 5+ years of senior leadership experience managing multi-layered teams (directors and managers) and external vendor or BPO partners • Deep knowledge of Medicare Advantage network requirements, including CMS network adequacy standards and HSD submissions, provider directory requirements (including Medicare Plan Finder submissions), NCQA credentialing standards, and audit readiness • Demonstrated experience translating complex provider contracts and payment methodologies (fee-for-service, capitation, and value-based arrangements) into accurate claims configuration • Proven record of improving operational KPIs through process redesign, data governance, and technology • Bachelor's degree or equivalent combination of education and experience • Experience scaling network operations through multi-state expansion at a high-growth or technology-enabled health plan, including D-SNP and C-SNP products • Hands-on experience implementing provider data management or MDM platforms, roster automation, AI or RPA solutions, and FHIR-based provider directory standards

🏖️ 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

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