VP Network Operations
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Job Description
VP leading provider network operations for Devoted Health’s Medicare Advantage plans. Scaling provider data, claims configuration, performance management, and automation across expanding markets.
Responsibilities:
- Own the operational backbone of Devoted's provider network through provider data and performance decisions
- Scale a performance management operation overseeing thousands of providers with automated, data-driven processes
- Report to the SVP / Chief Network Officer and lead a team
- Partner with Network Contracting, Engineering, Claims, Compliance, Finance, and Devoted Medical
- Set the vision, roadmap, budget, staffing model, and vendor strategy for Network Operations
- Build a high-performing team aligned with market expansion plans and annual CMS bid cycles
- Ensure negotiated agreements are loaded and configured accurately for claims payment
- Reduce contract-to-configuration cycle times and payment errors with Claims and Payment Integrity
- Lead provider engagement and build a provider performance scorecard
- Assist markets with providers’ financial review, unit cost analysis, and market trend interventions
- Partner with Engineering and Product to automate high-volume workflows
- Build KPIs and dashboards enabling Network Operations to scale without proportional headcount growth
Requirements:
- 12+ years of health plan or managed care experience, including 7+ years leading provider network operations functions such as provider data management, contract configuration, credentialing, or provider service
- 5+ years of senior leadership experience managing multi-layered teams (directors and managers) and external vendor or BPO partners
- Deep knowledge of Medicare Advantage network requirements, including CMS network adequacy standards and HSD submissions, provider directory requirements (including Medicare Plan Finder submissions), NCQA credentialing standards, and audit readiness
- Demonstrated experience translating complex provider contracts and payment methodologies (fee-for-service, capitation, and value-based arrangements) into accurate claims configuration
- Proven record of improving operational KPIs through process redesign, data governance, and technology
- Bachelor's degree or equivalent combination of education and experience
- Experience scaling network operations through multi-state expansion at a high-growth or technology-enabled health plan, including D-SNP and C-SNP products
- Hands-on experience implementing provider data management or MDM platforms, roster automation, AI or RPA solutions, and FHIR-based provider directory standards
Benefits:
- Employer sponsored health, dental and vision plan with low or no premium
- Generous paid time off
- $100 monthly mobile or internet stipend
- Stock options for all employees
- Bonus eligibility for all roles excluding Director and above
- Parental leave program
- 401K program
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