Director, Qualification Engagement

Responsibilities:

• Deliver qualification, requalification, and standing-change decisions to practices and specialists, including approvals, holds, denials, and removals.
• Own the adverse-finding workflow, including documentation requests, response tracking, and closing loops within service levels.
• Handle pushback with composure, explaining rationale and escalating only when warranted.

Practice and Specialist Education:

• Build and maintain practice-facing explanations of qualification domains, data sources, and thresholds.
• Lead overview conversations to ensure groups understand requirements before applying, and set standards for Provider Success Managers.
• Communicate guideline changes and re-evaluation pathways to affected practices.

Process Operations and Metrics:

• Own the workflow from Committee decision to delivered communication, including letter generation, tracking, and turnaround reporting.
• Coordinate the Qualification Committee agenda and decision record, and ensure timely handoff to Network.
• Capture and triage practice feedback, defining and reporting process metrics.

Clinical Representation and Leadership:

• Serve as Clinical representative on provider calls requiring clinical context, and represent the Clinical team in select commercial pitches and client conversations.
• Set the strategy, operating model, and service levels for qualification engagement, building the staffing case and representing the function in leadership forums.