Scope and Impact
This is a high-impact leadership opportunity at a growth-oriented, performance-driven organization. As Director of Provider Network Operations, you will shape and elevate the provider network strategy across the market — strengthening physician partnerships, advancing delegated performance, and building the infrastructure required for scalable expansion.
This role offers true latitude to modernize provider engagement, refine contracting strategy, and position the network for long-term success. With the prior director retired, this is a rare opportunity to step into an open canvas and leave a lasting imprint on how the organization partners with physicians, performs with health plans, and scales for future growth.
The impact is meaningful and visible. What you build here will directly influence market expansion, delegated performance, and the organization’s reputation as a premier physician-aligned partner.
About the Position The Director of Provider Network Operations provides strategic leadership for the evolution, performance, and long-term strength of the organization’s provider network across established and expansion markets. This role shapes network strategy, elevates physician partnerships, and ensures the infrastructure required to support scalable growth under delegated Medicare Advantage arrangements.
The Director advances network development and performance improvement initiatives while refining contracting strategy, operational frameworks, and alignment with delegated expectations. As the organization grows, the network architecture must remain disciplined, adaptable, and positioned to support additional lines of business, including Medicaid, Exchange, and Commercial products.
As a technology-enabled MSO, the Director champions the integration of advanced analytics and digital platforms to enhance provider engagement, operational efficiency, quality performance, and member experience.
Success in this role is defined by the ability to align provider network strategy with sustainable membership growth, total cost of care performance, delegated contract excellence, regulatory standards, and long-term financial strength.
Key Responsibilities
Leadership, Budgeting & Strategic Planning
Contract Implementation & Provider Engagement
Network Growth & Value-Based Performance
Technology Integration & Innovation
Regulatory Compliance & Delegation Oversight
Financial & Enterprise Performance Contribution
Reporting & Cross-Functional Alignment
Experience
Minimum five (5) years in a leadership role in provider network operations, managed care, IPA, or MSO settings.
Minimum three (3) years of Medicare Advantage experience required; experience in delegated or global risk models strongly preferred.
Demonstrated experience with:
PCP recruitment and provider engagement.
Operational implementation of executed provider contracts.
Identification and strategic conversion of non-participating providers to aligned contracted partners.
Network adequacy planning and gap remediation.
Value-based performance alignment.
Ability to interpret financial and operational data to guide strategic decisions.
Strong executive presence and communication skills.
Qualifications
Bachelor’s degree in Healthcare Administration, Business, or related field required; Master’s degree preferred.
Demonstrated understanding of PMPM, MLR, total cost of care, and risk-adjusted payment models.
Knowledge of CMS Medicare Advantage regulations and NCQA standards.
Excellent written and verbal communication skills.
Proficiency in Google Workspace, Microsoft Office and performance reporting tools.
Ability to manage sensitive and confidential information in accordance with HIPAA and applicable regulations.
About the Company’s Culture This company fosters a collaborative, inclusive, and performance-driven culture grounded in respect, accountability, and innovation. The organization emphasizes teamwork, continuous improvement, and a professional, engaging work environment, with leaders expected to model these values and drive operational excellence across departments. Work is carried out within established policies and procedures, with a strong focus on supporting organizational growth, fiscal stewardship, proposal development, performance monitoring and analysis, and compliance with local, state, and federal regulations, as well as relevant regulatory and licensing bodies. This organization is committed to equal access and opportunity in employment and the workplace, maintaining an inclusive environment free from discrimination based on race, color, creed, religion, national origin, gender, age, marital status, disability, public assistance status, veteran status, sexual orientation, gender identity, or gender expression.
The successful director will receive a compelling compensation package with a strong performance-based bonus opportunity.
Presented by Erica Eikelboom, Principal, Morgan Consulting Resources erica@morganconsulting.com
Full Position Summary The Director of Provider Network Operations provides strategic leadership for the growth, operational discipline and regulatory alignment of the provider network across assigned markets.
The role is currently focused on provider network strategy and execution supporting delegated Medicare Advantage operations. In alignment with organizational growth objectives, the Director is responsible for advancing and sustaining network infrastructure, contracting processes, and operational frameworks that remain scalable and adaptable should the organization expand into additional lines of business, including Medicaid, Exchange, or Commercial products.
As a technology-enabled MSO, the Company expects the Director to champion integration of digital tools and analytics platforms across the provider network to enhance operational efficiency, quality outcomes, and member experience.
The Director drives alignment of provider network strategies with membership growth, total cost of care performance, delegated contract expectations, regulatory compliance, and long-term financial sustainability.
Key Responsibilities Leadership, Budgeting & Strategic Planning
In collaboration with executive leadership, contribute in annual planning and performance oversight of Provider Network Operations budgets and targets.
Define and advance strategic priorities for network expansion, density optimization, and provider alignment consistent with organizational growth objectives.
Develop annual operating plans that include recruitment strategies, non-participating provider engagement initiatives, annual training and compliance reviews, and performance improvement roadmaps.
Project infrastructure, workforce, and market needs to support new contracts, new service lines, and health plan relationships.
Contribute to long-term strategic planning related to delegated risk performance and value-based care growth.
Develop and execute provider network build-out strategies in new geographic markets.
Contract Implementation & Provider Engagement
Provide leadership for operational implementation of executed provider contracts, supporting timely onboarding, credentialing coordination, reporting processes, and performance monitoring.
Oversee alignment of contractual requirements, service-level expectations, and delegated obligations with operational workflows and defined quality standards.
Lead structured engagement strategies to evaluate and convert non-participating providers to contracted status when aligned with organizational strategy, quality standards, and financial objectives.
Cultivate executive-level relationships with key PCPs, specialists, facilities, and ancillary providers to promote retention, alignment, and performance improvement.
Contract negotiation authority remains with executive leadership and legal counsel; the Director provides operational leadership for post-execution integration and provider alignment.
Network Growth & Value-Based Performance
Lead PCP and specialist recruitment efforts aligned with market strategy and delegated contract performance expectations.
Promote provider engagement in value-based care initiatives, including RAF documentation accuracy, Annual Wellness Visit (AWV) performance, care gap closure, referral management, and cost-of-care awareness.
Collaborate with Medical Management and Analytics to translate PMPM, MLR, utilization, and STAR data into actionable provider-facing strategies.
Support development and operational implementation of incentive structures aligning provider behavior with quality, utilization, and financial goals.
Track attributed membership growth, provider retention, and performance trends to inform strategic adjustments.
Demonstrated understanding of provider reimbursement methodologies — including fee-for-service (RBRVS, DRG, ICD-10-based structures), prospective payment systems, capitation, and percent-of-premium models — and their alignment with delegated risk and total cost of care performance.
Technology Integration & Innovation
Guide network readiness and adoption of emerging technologies that enhance patient care delivery, documentation accuracy, access, and member experience.
Partner with Operations, Analytics, and Technology teams to deploy digital tools that improve workflow efficiency, provider performance visibility, and care coordination.
Encourage provider education and engagement to facilitate adoption of enterprise technology platforms and reporting systems.
Identify opportunities to leverage automation and analytics to advance provider performance and patient outcomes.
Support provider-driven adoption of enterprise digital tools, including the member mobile application, in alignment with marketing and member engagement initiatives.
Regulatory Compliance & Delegation Oversight
Collaborate with the Compliance Department to operationalize policies and procedures consistent with CMS Medicare Advantage regulations, NCQA standards, and contractual obligations as they pertain to provider network functions.
In anticipation of potential participation in Medicaid or other payer programs, coordinate with Compliance to support credentialing, enrollment, and provider qualification processes that meet applicable federal and state requirements.
Support monitoring of network adequacy requirements and coordinate timely submission of required regulatory reports and rosters within the provider network domain.
Partner with Compliance to prepare for audits, delegation oversight reviews, and implementation of corrective action plans impacting provider network operations.
Communicate operational considerations related to regulatory updates and support implementation of compliance-driven initiatives within the network function.
Financial & Enterprise Performance Contribution
Collaborate with Finance and Executive Leadership on performance dashboards tied to PMPM, MLR, and total cost of care objectives.
Identify operational improvements to enhance provider performance and administrative efficiency.
Support enterprise initiatives aimed at achieving EBITDA and shared-savings performance targets.
Advance alignment of provider network initiatives with broader enterprise financial strategy.
Reporting & Cross-Functional Alignment
Represent the organization in Joint Operating Committee (JOC) and health plan performance meetings related to network operations, HEDIS, risk adjustment (HCC), and delegated performance metrics.
Partner with Reporting Analytics to integrate network data with Quality and Risk Adjustment initiatives.
Support STAR performance targets (>4.0) through structured provider oversight and engagement.
Prepare executive-ready summaries of network growth, performance metrics, and risk trends.
Represent Provider Network Operations in leadership meetings, board discussions, and health plan partner forums.
Collaborate across departments to ensure coordinated execution of enterprise initiatives impacting network performance.
Experience
Minimum five (5) years in a leadership role in provider network operations, managed care, IPA, or MSO settings.
Minimum three (3) years of Medicare Advantage experience required; experience in delegated or global risk models strongly preferred.
Demonstrated experience with:
PCP recruitment and provider engagement
Operational implementation of executed provider contracts
Identification and strategic conversion of non-participating providers to aligned contracted partners
Network adequacy planning and gap remediation
Value-based performance alignment
Ability to interpret financial and operational data to guide strategic decisions.
Strong executive presence and communication skills
Qualifications
Bachelor’s degree in Healthcare Administration, Business, or related field required; Master’s degree preferred.
Demonstrated understanding of PMPM, MLR, total cost of care, and risk-adjusted payment models.
Knowledge of CMS Medicare Advantage regulations and NCQA standards.
Excellent written and verbal communication skills.
Proficiency in Google Workspace, Microsoft Office and performance reporting tools.
Ability to manage sensitive and confidential information in accordance with HIPAA and applicable regulations.
#J-18808-Ljbffr
This role offers true latitude to modernize provider engagement, refine contracting strategy, and position the network for long-term success. With the prior director retired, this is a rare opportunity to step into an open canvas and leave a lasting imprint on how the organization partners with physicians, performs with health plans, and scales for future growth.
The impact is meaningful and visible. What you build here will directly influence market expansion, delegated performance, and the organization’s reputation as a premier physician-aligned partner.
About the Position The Director of Provider Network Operations provides strategic leadership for the evolution, performance, and long-term strength of the organization’s provider network across established and expansion markets. This role shapes network strategy, elevates physician partnerships, and ensures the infrastructure required to support scalable growth under delegated Medicare Advantage arrangements.
The Director advances network development and performance improvement initiatives while refining contracting strategy, operational frameworks, and alignment with delegated expectations. As the organization grows, the network architecture must remain disciplined, adaptable, and positioned to support additional lines of business, including Medicaid, Exchange, and Commercial products.
As a technology-enabled MSO, the Director champions the integration of advanced analytics and digital platforms to enhance provider engagement, operational efficiency, quality performance, and member experience.
Success in this role is defined by the ability to align provider network strategy with sustainable membership growth, total cost of care performance, delegated contract excellence, regulatory standards, and long-term financial strength.
Key Responsibilities
Leadership, Budgeting & Strategic Planning
Contract Implementation & Provider Engagement
Network Growth & Value-Based Performance
Technology Integration & Innovation
Regulatory Compliance & Delegation Oversight
Financial & Enterprise Performance Contribution
Reporting & Cross-Functional Alignment
Experience
Minimum five (5) years in a leadership role in provider network operations, managed care, IPA, or MSO settings.
Minimum three (3) years of Medicare Advantage experience required; experience in delegated or global risk models strongly preferred.
Demonstrated experience with:
PCP recruitment and provider engagement.
Operational implementation of executed provider contracts.
Identification and strategic conversion of non-participating providers to aligned contracted partners.
Network adequacy planning and gap remediation.
Value-based performance alignment.
Ability to interpret financial and operational data to guide strategic decisions.
Strong executive presence and communication skills.
Qualifications
Bachelor’s degree in Healthcare Administration, Business, or related field required; Master’s degree preferred.
Demonstrated understanding of PMPM, MLR, total cost of care, and risk-adjusted payment models.
Knowledge of CMS Medicare Advantage regulations and NCQA standards.
Excellent written and verbal communication skills.
Proficiency in Google Workspace, Microsoft Office and performance reporting tools.
Ability to manage sensitive and confidential information in accordance with HIPAA and applicable regulations.
About the Company’s Culture This company fosters a collaborative, inclusive, and performance-driven culture grounded in respect, accountability, and innovation. The organization emphasizes teamwork, continuous improvement, and a professional, engaging work environment, with leaders expected to model these values and drive operational excellence across departments. Work is carried out within established policies and procedures, with a strong focus on supporting organizational growth, fiscal stewardship, proposal development, performance monitoring and analysis, and compliance with local, state, and federal regulations, as well as relevant regulatory and licensing bodies. This organization is committed to equal access and opportunity in employment and the workplace, maintaining an inclusive environment free from discrimination based on race, color, creed, religion, national origin, gender, age, marital status, disability, public assistance status, veteran status, sexual orientation, gender identity, or gender expression.
The successful director will receive a compelling compensation package with a strong performance-based bonus opportunity.
Presented by Erica Eikelboom, Principal, Morgan Consulting Resources erica@morganconsulting.com
Full Position Summary The Director of Provider Network Operations provides strategic leadership for the growth, operational discipline and regulatory alignment of the provider network across assigned markets.
The role is currently focused on provider network strategy and execution supporting delegated Medicare Advantage operations. In alignment with organizational growth objectives, the Director is responsible for advancing and sustaining network infrastructure, contracting processes, and operational frameworks that remain scalable and adaptable should the organization expand into additional lines of business, including Medicaid, Exchange, or Commercial products.
As a technology-enabled MSO, the Company expects the Director to champion integration of digital tools and analytics platforms across the provider network to enhance operational efficiency, quality outcomes, and member experience.
The Director drives alignment of provider network strategies with membership growth, total cost of care performance, delegated contract expectations, regulatory compliance, and long-term financial sustainability.
Key Responsibilities Leadership, Budgeting & Strategic Planning
In collaboration with executive leadership, contribute in annual planning and performance oversight of Provider Network Operations budgets and targets.
Define and advance strategic priorities for network expansion, density optimization, and provider alignment consistent with organizational growth objectives.
Develop annual operating plans that include recruitment strategies, non-participating provider engagement initiatives, annual training and compliance reviews, and performance improvement roadmaps.
Project infrastructure, workforce, and market needs to support new contracts, new service lines, and health plan relationships.
Contribute to long-term strategic planning related to delegated risk performance and value-based care growth.
Develop and execute provider network build-out strategies in new geographic markets.
Contract Implementation & Provider Engagement
Provide leadership for operational implementation of executed provider contracts, supporting timely onboarding, credentialing coordination, reporting processes, and performance monitoring.
Oversee alignment of contractual requirements, service-level expectations, and delegated obligations with operational workflows and defined quality standards.
Lead structured engagement strategies to evaluate and convert non-participating providers to contracted status when aligned with organizational strategy, quality standards, and financial objectives.
Cultivate executive-level relationships with key PCPs, specialists, facilities, and ancillary providers to promote retention, alignment, and performance improvement.
Contract negotiation authority remains with executive leadership and legal counsel; the Director provides operational leadership for post-execution integration and provider alignment.
Network Growth & Value-Based Performance
Lead PCP and specialist recruitment efforts aligned with market strategy and delegated contract performance expectations.
Promote provider engagement in value-based care initiatives, including RAF documentation accuracy, Annual Wellness Visit (AWV) performance, care gap closure, referral management, and cost-of-care awareness.
Collaborate with Medical Management and Analytics to translate PMPM, MLR, utilization, and STAR data into actionable provider-facing strategies.
Support development and operational implementation of incentive structures aligning provider behavior with quality, utilization, and financial goals.
Track attributed membership growth, provider retention, and performance trends to inform strategic adjustments.
Demonstrated understanding of provider reimbursement methodologies — including fee-for-service (RBRVS, DRG, ICD-10-based structures), prospective payment systems, capitation, and percent-of-premium models — and their alignment with delegated risk and total cost of care performance.
Technology Integration & Innovation
Guide network readiness and adoption of emerging technologies that enhance patient care delivery, documentation accuracy, access, and member experience.
Partner with Operations, Analytics, and Technology teams to deploy digital tools that improve workflow efficiency, provider performance visibility, and care coordination.
Encourage provider education and engagement to facilitate adoption of enterprise technology platforms and reporting systems.
Identify opportunities to leverage automation and analytics to advance provider performance and patient outcomes.
Support provider-driven adoption of enterprise digital tools, including the member mobile application, in alignment with marketing and member engagement initiatives.
Regulatory Compliance & Delegation Oversight
Collaborate with the Compliance Department to operationalize policies and procedures consistent with CMS Medicare Advantage regulations, NCQA standards, and contractual obligations as they pertain to provider network functions.
In anticipation of potential participation in Medicaid or other payer programs, coordinate with Compliance to support credentialing, enrollment, and provider qualification processes that meet applicable federal and state requirements.
Support monitoring of network adequacy requirements and coordinate timely submission of required regulatory reports and rosters within the provider network domain.
Partner with Compliance to prepare for audits, delegation oversight reviews, and implementation of corrective action plans impacting provider network operations.
Communicate operational considerations related to regulatory updates and support implementation of compliance-driven initiatives within the network function.
Financial & Enterprise Performance Contribution
Collaborate with Finance and Executive Leadership on performance dashboards tied to PMPM, MLR, and total cost of care objectives.
Identify operational improvements to enhance provider performance and administrative efficiency.
Support enterprise initiatives aimed at achieving EBITDA and shared-savings performance targets.
Advance alignment of provider network initiatives with broader enterprise financial strategy.
Reporting & Cross-Functional Alignment
Represent the organization in Joint Operating Committee (JOC) and health plan performance meetings related to network operations, HEDIS, risk adjustment (HCC), and delegated performance metrics.
Partner with Reporting Analytics to integrate network data with Quality and Risk Adjustment initiatives.
Support STAR performance targets (>4.0) through structured provider oversight and engagement.
Prepare executive-ready summaries of network growth, performance metrics, and risk trends.
Represent Provider Network Operations in leadership meetings, board discussions, and health plan partner forums.
Collaborate across departments to ensure coordinated execution of enterprise initiatives impacting network performance.
Experience
Minimum five (5) years in a leadership role in provider network operations, managed care, IPA, or MSO settings.
Minimum three (3) years of Medicare Advantage experience required; experience in delegated or global risk models strongly preferred.
Demonstrated experience with:
PCP recruitment and provider engagement
Operational implementation of executed provider contracts
Identification and strategic conversion of non-participating providers to aligned contracted partners
Network adequacy planning and gap remediation
Value-based performance alignment
Ability to interpret financial and operational data to guide strategic decisions.
Strong executive presence and communication skills
Qualifications
Bachelor’s degree in Healthcare Administration, Business, or related field required; Master’s degree preferred.
Demonstrated understanding of PMPM, MLR, total cost of care, and risk-adjusted payment models.
Knowledge of CMS Medicare Advantage regulations and NCQA standards.
Excellent written and verbal communication skills.
Proficiency in Google Workspace, Microsoft Office and performance reporting tools.
Ability to manage sensitive and confidential information in accordance with HIPAA and applicable regulations.
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