Director, Network Operations

Experience Required:

• 8+ years in healthcare network operations, provider data management, or credentialing, with deep Medicare Advantage expertise.
• Proven track record in transforming data infrastructures and managing third-party vendors with strict performance standards.
• Exceptional AI-forward mindset with experience in LLMs and building automated data pipelines for a PDM "Golden Record."

Responsibilities:

• Own the provider data management platform, ensuring compliance with CMS and NCQA standards while driving continuous improvement in directory accuracy.
• Serve as primary lead for strategic oversight of credentialing partners and BPaaS vendors, using data-driven metrics to synchronize workflows.
• Manage, mentor, and scale a fully remote team, fostering an inclusive culture centered on accountability and technological fluency.

Success Metrics:

• By 90 days: Gain proficiency in core software, integrate with the team, and kick off a directory quality audit while mapping automation opportunities.
• By 6 months: Complete the audit, implement systemic enhancements, and deploy AI oversight mechanics for ongoing compliance.
• Continued success: Position Clover as market leader in directory reliability, transforming the department into a proactive, technologically advanced powerhouse.