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The Senior Director, Network Administration & Enablement is responsible for leading the design, execution, and enablement of network strategy, provider data management, and analytics. This position supports the development, maintenance, and performance of provider networks across all lines of business. A successful candidate will require deep expertise in provider payment methodologies, value-based care models, and healthcare data analytics. The Director will be responsible for building and leading a strategic network framework, managing a team, and collaborating with cross-functional stakeholders, to enhance network efficiency, quality, cost-effectiveness, while maintaining compliance.

What you'll do:

• Operationalizing network administration across Collective Health
• Partnering with stakeholders across the business, develop and implement comprehensive provider network operations aligned with organizational goals.
• Enable new direct to provider contracts, hospital systems network and initiatives.
• Responsible for vendor management and ensuring scalable processes related to provider contracts/pricing.
• Provider Data Management:
  • Develop and implement strategies for efficient provider data administration and management, support credentialing and contracting workflows, lead initiatives that enable a high-performing provider network, and ensure data accuracy and integrity.
  • Oversee the onboarding and maintenance of provider data from health systems and self-insured clients.
  • Establish and maintain data quality standards and procedures.
  • Support provider directory accuracy, including routine audits and remediation in compliance with CMS and state regulations.
  • Monitor network adequacy, identifying gaps in geographic and specialty coverage using internal tools and analytics.
• Provider Payment Methodologies:
  • Expertise in provider payment methodologies, including capitation, pay for performance, fee for service, bundled payments, and other innovative models.
  • Monitor and analyze payment trends and make recommendations for optimization.
• Provider Data Management and Analytics:
  • Oversee the management and integrity of provider data, ensuring accuracy and compliance. Including managing any and all processes related to creating and updating provider data and distilling across teams.
  • Lead the development of advanced analytics and reporting, through a strong partnership with the Data & Analytics team to monitor performance, identify trends, and inform decision-making.
  • Utilize data to drive improvements in provider engagement, cost management, and quality outcomes.
• Team Leadership and Collaboration:
  • Build, lead and mentor a team of analysts and specialists, fostering a culture of high performance and continuous improvement.
  • Collaborate with internal and external stakeholders, including providers, payers, and technology partners.
  • Provide strategic guidance and support to cross-functional teams on network-related initiatives.
• Compliance and Regulatory Oversight:
  • Ensure compliance with federal and state regulatory standards, including NCQA, CMS, and state agencies.
  • Participate in audits and reporting requirements related to network administration and provider data integrity.
  • Support continuous improvement initiatives focused on data governance, automation, and operational excellence.

To be successful in this role, you'll need:

• Bachelor's degree in Healthcare Administration, Business Administration, Information Management, or a related field; Master's degree preferred.
• 15+ years of experience in the healthcare industry, with a focus on provider network management, value-based care, and data analytics.
• Deep knowledge of provider payment methodologies, including capitation, pay for performance, fee for service, etc.
• Extensive experience in value-based care models, ACO management, and alternative payment models.
• Proven ability to develop and implement network strategies and initiatives.
• Strong analytical skills and experience with data analysis and reporting tools.
• Excellent communication, interpersonal, and leadership skills.
• Strong organizational and problem-solving abilities.
• In-depth understanding of healthcare industry regulations and data privacy standards (e.g., HIPAA).

Pay Transparency Statement

This is a hybrid position based out of our Lehi office, with the expectation of being in office at least two weekdays per week. #LI-hybrid

The actual pay rate offered within the range will depend on factors including geographic location, qualifications, experience, and internal equity. In addition to the salary, you will be eligible for stock options and benefits like health insurance, 401k, and paid time off. Learn more about our benefits at https://jobs.collectivehealth.com/benefits/.