Director of Provider & Network Operations

The Director of Provider & Network Operations leads the end-to-end provider lifecycle and payer participation functions, ensuring timely onboarding, credentialing, enrollment, and operational readiness across the organization's provider network. This role is accountable for maintaining regulatory compliance, mitigating revenue risk, and strengthening payer relationships while partnering with internal stakeholders to align provider operations with broader organizational objectives.

Payer Strategy & Relationship Leadership

Serve as the organizational authority for payer partnerships, overseeing strategic relationships with commercial, Medicaid, and third-party administrators. Lead ongoing engagement, issue resolution, and performance oversight to ensure network participation, reimbursement alignment, and operational continuity.

Contracting & Reimbursement Optimization

Lead negotiation and optimization of payer contracts, reimbursement rates, and fee schedules in alignment with financial performance objectives. Evaluate contract terms, assess reimbursement structures, and advise leadership on payer participation strategy while ensuring regulatory and contractual compliance.

Provider Lifecycle & Network Operations

Provide enterprise oversight of the provider lifecycle, including onboarding, credentialing, enrollment, and network participation across a multi-site provider network. Ensure timely provider activation and reimbursement readiness to support uninterrupted patient access and revenue flow.

Provider Coverage & Operational Continuity

Manage and coordinate provider schedule changes throughout the organization, proactively addressing call-outs, PTO, illness, and other disruptions to ensure adequate doctor coverage and minimize disruption to patient care

Credentialing Governance & Compliance

Establish and maintain credentialing standards, policies, and infrastructure to ensure compliance with federal, state, payer, and accreditation requirements. Oversee verification of provider qualifications, licensure, certifications, and regulatory adherence to mitigate operational and compliance risk.

Operational Infrastructure & Data Governance

Direct the development and maintenance of provider credentialing systems and data governance frameworks, ensuring accuracy across internal systems and external payer platforms. Maintain visibility into expirations, renewals, enrollment status, and risk indicators.

Professional Liability (Malpractice) Oversight

Provide oversight of professional liability (malpractice) coverage across the provider network, ensuring continuous compliance with legal, payer, and contractual requirements. Coordinate provider onboarding into coverage plans, policy adds/deletes, and coverage updates in alignment with credentialing and payer enrollment processes.

Proactively monitor renewal timelines and coverage status to prevent lapses that could delay credentialing, restrict payer participation, postpone provider go-live, or disrupt reimbursement readiness. Mitigate operational and compliance risk by ensuring alignment between liability coverage, provider participation, and regulatory standards.

Cross-Functional Leadership

Partner with Operations, Revenue Cycle, HR, IT, and clinical leadership to align provider onboarding, payer participation, and operational readiness with organizational growth objectives. Serve as escalation authority for provider and payer participation issues impacting access.

Process Optimization & Risk Mitigation

Drive continuous improvement initiatives across provider network and payer operations to enhance efficiency, reduce activation delays, and mitigate reimbursement risk. Identify bottlenecks and implement scalable solutions that improve turnaround times and operational transparency.

Analytics & Performance Reporting

Provide executive-level reporting and analytics on payer performance, reimbursement trends, credentialing timelines, enrollment status, and operational risk indicators. Leverage data insights to inform decision-making and identify opportunities for financial optimization.

Dispute & Issue Resolution

Lead resolution of reimbursement disputes, participation discrepancies, and term interpretation matters, serving as the primary intermediary between the organization and payers to protect financial and operational interests.

Market Intelligence & Strategic Insight

Monitor industry trends, payer policy changes, competitive dynamics, and emerging reimbursement models to proactively position the organization for sustainable network growth and operational resilience.

Financial Perspective:

Ensure operational alignment of provider credentialing, payer participation, and enrollment processes to protect revenue continuity, minimize reimbursement delays, and mitigate financial risk. Optimize payer reimbursement structures and support contract strategy to enhance network performance and financial sustainability.

Patient Perspective:

Drive a seamless provider lifecycle experience from onboarding through network participation, ensuring timely activation and operational readiness to support uninterrupted patient access and high-quality care delivery. Maintain professional, transparent communication with providers and payer partners to reinforce trust and operational confidence.

Internal Perspective:

Provide enterprise-level leadership and cross-functional coordination across Operations, Revenue Cycle, IT, HR, and Compliance to ensure provider network infrastructure supports organizational growth objectives. Establish standardized processes, governance frameworks, and reporting mechanisms that enhance efficiency, scalability, and accountability.

External Perspective:

Represent the organization in all payer and provider interactions, reinforcing the organization's reputation for operational integrity, compliance, and strategic partnership. Maintain productive payer relationships that support sustainable network participation and competitive positioning within the market.

Risk Perspective:

Oversee credentialing governance and payer participation processes in accordance with federal, state, accreditation, and contractual requirements. Identify and mitigate operational, compliance, and reimbursement risks that may impact provider participation, regulatory standing, or financial performance.

Learning & Growth Perspective:

Drive continuous improvement initiatives across provider network operations, leveraging data, feedback, and industry trends to enhance efficiency, strengthen payer alignment, and improve provider engagement. Promote a culture of operational excellence, accountability, and scalable process design.

Strategic Leadership

o Demonstrates enterprise-level thinking and operational foresight

o Makes data-informed decisions aligned with organizational financial and growth objectives

o Exercises independent judgment in high-impact, complex situations

Executive Communication

o Communicates effectively with executive leadership, providers, payers, and cross-functional stakeholders

o Translates operational data into actionable insights

o Influences outcomes through professional, solution-oriented dialogue

Accountability & Ownership

o Takes full ownership of provider network performance and payer operations outcomes

o Operates with integrity, discretion, and high ethical standards

o Proactively identifies risks and implements mitigation strategies

Professionalism

o Ability to work well under pressure

o Professional appearance, dress, and attitude

o Punctuality

Relationship & Stakeholder Management

o Builds and maintains strategic partnerships with payers, providers, and internal leadership

o Navigates complex negotiations and conflict resolution effectively

o Aligns diverse stakeholders toward shared operational and financial objectives

Organizational Influence

o Leads cross-functional initiatives without direct authority

o Drives process improvements and scalable infrastructure, o Advanced knowledge of credentialing governance, payer enrollment, and network participation strategy

o Deep understanding of reimbursement structures, fee schedules, and contract performance

Financial & Analytical Acumen

o Ability to analyze reimbursement trends, payer performance metrics, and operational risk indicators

o Experience supporting contract negotiations and revenue optimization strategies

Operational Infrastructure & Systems

o Expertise in credentialing platforms, payer systems, and provider data governance tools

o Ability to design reporting frameworks and scalable process architecture

Regulatory & Compliance Oversight

o Strong knowledge of federal, state, payer, and accreditation standards

o Experience ensuring compliance across multi-site provider operations, * Bachelor's degree in Healthcare Administration, Business, or related field preferred. Equivalent progressive leadership experience in healthcare operations, managed care, provider network administration, or revenue cycle environments will be considered.

• 5+ years of progressive experience in healthcare operations, provider network management, managed care, credentialing, payer contracting, or related revenue-supporting functions.
• Demonstrated expertise in provider lifecycle management, payer relations, reimbursement strategy, and operational governance within multi-site healthcare environments.
• Proven ability to lead and optimize credentialing and payer participation operations while contributing to broader operational performance initiatives.
• Strong negotiation and executive-level communication skills, with the ability to influence payer partners and collaborate cross-functionally across Revenue Cycle, Operations, HR, Compliance, IT, and Clinical teams.
• Analytical mindset with experience interpreting reimbursement data, operational metrics, and network performance trends to support leadership decision-making.
• Working knowledge of healthcare regulatory requirements, including HIPAA, payer participation standards, and delegated credentialing compliance.
• Experience implementing and enhancing credentialing, enrollment, provider data management, or operational reporting systems.
• Demonstrated leadership capability with the ability to manage priorities, mitigate operational risk, and drive process improvement initiatives.
• High level of professional judgment, accountability, and adaptability in a dynamic healthcare environment.

United Dental Partners 2.62.6 out of 5 stars 4849 4849 N Milwaukee Ave, Chicago, IL 60630 $100,000 - $111,000 a year - Full-time