Note: The job is a remote job and is open to candidates in USA. SCAN is a nonprofit health organization dedicated to improving care for older adults. The Director, Provider Data Operations will ensure provider information is accurate and trusted across the enterprise while driving improvements in data management and governance.
Responsibilities
- Leads end-to-end provider data operations, including provider hierarchy, provider records, verification, roster management, reconciliation, delegated oversight, audit readiness, issue resolution, and continuous improvement
- Owns provider data accuracy and directory integrity by establishing quality standards, validation controls, audit processes, and root-cause resolution to prevent recurring data defects. Responsible for data accuracy on internal and external provider directories
- Drives strategy and governance for provider data as a trusted enterprise source of truth, including policies, procedures, business rules, data stewardship, and alignment with downstream systems and workflows. Contributes to planning, direction, and goal setting for the department or function in collaboration with senior management
- Ensures regulatory and business readiness by maintaining controls that support CMS and state requirements, network adequacy, provider directory accuracy, product participation, provider terminations, and delegated oversight
- Understands and implement new and future compliance requirements. Supports critical business strategies by providing systematic solutions and/or recommendations on business processes. Proficient in navigating legislative changes, federal and state regulations, to direct teams to make necessary changes
- Directs small and medium projects and initiatives. Define and deliver initiatives according to agreed-upon business requirements and timelines
- Partners across Operations, Technology, Network Management, Compliance, Product, Digital, vendors, and delegated provider groups to integrate, govern, and improve provider data across enterprise processes
- Leads implementation, optimization, and oversight of provider data applications, vendor solutions, automation, and AI-enabled capabilities that improve accuracy, efficiency, workflow performance, and decision-making
- Monitors performance against KPIs, SLAs, quality measures, and risk indicators; translate trends into actionable insights, recommendations, and operational action plans. Proactively identifies opportunities for process improvements
- Establishes departmental policies, practices, and procedures that have a significant impact on the organization. Oversee the creation of document workflows and policies and procedures (P&Ps) as necessary
- Builds and develop a high-performing team by setting clear goals, accountability standards, training expectations, and a culture of service, innovation, continuous improvement, and data stewardship
- Establishes staffing needs and ensure consistent training for staff through adoption of standardized processes
- Actively support the achievement of SCAN’s Vision and Goals
- Other duties as assigned
Skills
- Bachelor's Degree or 5+ years equivalent work experience
- 2+ years of leadership experience
- 2+ years in leading Provider Data Management teams at managed care provider organization (IPA, Medical Group or institutional provider) or insurance company
- 5+ years of overall Healthcare experience
Benefits
- Remote
- An annual employee bonus program
- Robust Wellness Program
- Generous paid-time-off (PTO)
- 11 paid holidays per year, 1 floating holiday, birthday off, and 2 volunteer days
- Excellent 401(k) Retirement Saving Plan with employer match
- Robust employee recognition program
- Tuition reimbursement
- Birthday off
- 2 volunteer days
Company Overview
Company H1B Sponsorship