Provider Network Operations Director (Remote - US)

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Provider Network Operations Director in United States.

This leadership role provides the opportunity to oversee and enhance the operations of a complex provider network, ensuring high-quality service delivery and regulatory compliance. The Provider Network Operations Director will lead strategic initiatives that align network design, credentialing, enrollment, and operational workflows with organizational goals and accreditation standards. Acting as a key partner to senior leadership, this role focuses on optimizing provider access, managing data integrity, and implementing continuous process improvements. The ideal candidate will balance operational oversight with staff development, fostering a culture of collaboration, transparency, and performance excellence. This position requires exceptional analytical, negotiation, and communication skills, along with a strong understanding of mental health, substance use, and developmental disability service systems.

Accountabilities

• Lead operational strategy and execution for the provider network, including credentialing, enrollment, and provider data management.
• Ensure compliance with local, state, and federal regulations, as well as national accreditation standards.
• Develop and implement policies, procedures, and workflows to optimize network performance and member access.
• Partner with cross-functional teams to plan and execute network development initiatives, including RFPs, gap analyses, and capacity studies.
• Manage staff performance, provide coaching and professional development, and ensure a high-performing, well-trained team.
• Serve as a liaison between providers, internal teams, and external stakeholders to facilitate issue resolution and collaboration.
• Oversee technical and operational aspects of provider enrollment, contracting, sanctions, and appeal processes.

Requirements

• Bachelor’s Degree in mental health, public health, social work, psychology, education, sociology, business, or public administration; Master’s degree preferred.
• Minimum 5 years of experience in network operations, provider relations, or related management roles; 3 years of supervisory or consultative experience.
• Strong knowledge of Medicaid Transformation, managed care, and provider data management.
• Comprehensive understanding of mental health, substance use, and intellectual/developmental disability service systems.
• Proven leadership, negotiation, and conflict resolution skills.
• Excellent analytical, organizational, and problem-solving abilities.
• Strong communication, presentation, and interpersonal skills to interact effectively with internal and external stakeholders.
• Ability to travel as needed for job responsibilities. NC residency required.

Benefits

• Competitive compensation with annual incentive bonus plan.
• Comprehensive medical, dental, and vision insurance with low deductible/low cost options.
• Generous paid time off including vacation, sick time, and 12 paid holidays.
• State retirement (pension plan) and 401(k) with employer match.
• Company-paid life and disability insurance.
• Wellness programs and professional development opportunities.
• Public Service Loan Forgiveness qualifying employer.
• Supportive and collaborative work environment.

Jobgether is a Talent Matching Platform that partners with companies worldwide to efficiently connect top talent with the right opportunities through AI-driven job matching. When you apply, your profile goes through our AI-powered screening process designed to identify top talent efficiently and fairly.

🔍 Our AI evaluates your CV and LinkedIn profile thoroughly, analyzing your skills, experience, and achievements.
📊 It compares your profile to the job’s core requirements and past success factors to determine your match score.
🎯 Based on this analysis, we automatically shortlist the 3 candidates with the highest match to the role.
🧠 When necessary, our human team may perform an additional manual review to ensure no strong profile is missed.

The process is transparent, skills-based, and free of bias—focusing solely on your fit for the role. Once the shortlist is completed, it is shared directly with the company. The final decision and next steps (such as interviews or additional assessments) are made by their internal hiring team.

Thank you for your interest!