Network Operational Director

General Description

Provides operational leadership for Network Management initiatives, directing the end‑to‑end execution of operational efficiency and regulatory projects to ensure successful implementation across contracting, among other network management operational functions. Oversee core operational processes and lead project initiatives for the Network Management department in close partnership with the Enterprise Project Management Office (EPMO) and other departments within the organization. Aligns cross‑functional stakeholders, ensures compliance with applicable regulatory requirements, and drives disciplined execution. Serves as a key liaison to executive leadership by monitoring initiative progress, proactively mitigating risks, and communicating status, outcomes, and strategic recommendations in executive forums, while providing secondary support on regulatory matters led by senior leadership.

Regular Exempt

Essential Functions

• Direct operational efficiency and regulatory projects within the department, ensuring initiatives are delivered on scope, timeline, and regulatory requirements while achieving targeted performance outcomes.
• Provide strategic guidance to the EPMO and other departments, as applicable, by aligning internal and external stakeholders, clarifying priorities, resolving dependencies, and ensuring disciplined project governance and execution to ensure effective and timely implementation in the Network Management department.
• Monitor initiative performance, risks, and mitigation plans; prepare and present comprehensive status updates, dashboards, and recommendations in executive and senior leadership forums.
• Oversee and continuously optimize contracting and credentialing operational processes to support network adequacy, improve turnaround times (TAT), and enhance overall operational effectiveness.
• Support management on operational and regulatory initiatives by providing operational insights, impact assessments, and execution support as needed.
• Support departmental audits and regulatory readiness activities, ensuring accurate documentation, timely responses, and effective implementation of corrective action plans.
• Establish, track, and report key performance indicators (KPIs) and service level agreements (SLAs) to evaluate operational performance, identify gaps, and drive continuous improvement initiatives.
• Ensure the integrity, accuracy, and audit‑readiness of the provider's network by enforcing data quality controls and standardized operating practices across systems.
• Develop and maintain standardized operational documentation, including standard operating procedures (SOPs), process maps, and workflow guidelines, to ensure consistent and compliant execution across teams.
• Supervise, monitor, train, evaluate, and correct personnel to comply with company policies and ensure they fulfill their work plans and essential functions.
• Comply fully and consistently with all company policies and procedures, local and federal laws, and regulations applicable to the industry to maintain appropriate business and employment practices.
• May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.

Minimum Qualifications

Education and Experience: Master’s Degree in Public Health, Health Services Administration, Business Administration, or related areas. At least five (5) years of experience in healthcare compliance or operational process optimization, driving performance improvement initiatives within complex and highly regulated healthcare insurance environments. Proven experience in applying structured problem‑solving, root cause analysis, and continuous improvement methodologies to enhance operational effectiveness. At least two (2) years of experience supervising personnel.

OR

Education and Experience: Bachelor’s Degree in Public Health, Health Services Administration, Business Administration, or related areas. At least seven (7) years of experience in healthcare compliance or operational process optimization, driving performance improvement initiatives within complex and highly regulated healthcare insurance environments. Proven experience in applying structured problem‑solving, root cause analysis, and continuous improvement methodologies to enhance operational effectiveness. At least four (4) years of experience supervising personnel.

“Proven experience may be replaced by previously established requirements.”

Certifications / Licenses

A valid Project Management Professional (PMP) certification or Lean Six Sigma certification is preferred.

Other

Knowledge of audit practices, corrective action plans, and compliance monitoring in healthcare operations. Knowledge of data quality standards and best practices for maintaining accurate, audit‑ready records.

Languages

Spanish – Advanced (comprehensive, writing and verbal)

English – Advanced (comprehensive, writing and verbal)

Equal Employment Opportunity

We are an Equal Employment Opportunity Employer and take affirmative action to recruit protected veterans and individuals with disabilities.

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