Associate Director, Provider Network Operations & Planning

BrightonOne•Boston, MA

2d•$115,000 - $145,000•Hybrid

About The Position

The Associate Director, Provider Network Operations & Planning leads the back-office operations that keep the US Family Health Plan’s provider network accurate, adequate, and compliant. Reporting to senior leadership, the role oversees provider data management, network adequacy and planning, and initial and ongoing credentialing of the provider network— including delegated credentialing, provider data, network analytics, and similar platform vendors. The Associate Director is responsible for ensuring provider data accuracy, certification and credentialing issues and concerns, and providing accurate and prompt responses to internal and external inquiries. This role collaborates closely with department leaders to evaluate and refine processes to drive operational efficiency and achievement of performance metrics and goals while maintaining compliance with regulatory requirements and accreditation standards.

Requirements

Bachelor's degree required; Master's degree preferred.
8 or more years of provider network operations, provider data, or credentialing experience, including leadership required.
2 or more years of experience working with credentialing applications and provider data management systems to support end-to-end credentialing and data workflows required.
Working knowledge of URAC and/or NCQA accreditation standards, as well as VA, TRICARE, or other federal program regulatory requirements
Expertise in provider data management, network adequacy, and credentialing operations.
Demonstrated ability to lead teams, influence cross-functional collaboration, and translate strategy into measurable outcomes.
Ability to analyze data, prepare reports, and manage multiple priorities under deadlines.
Strong analytical, operational, and leadership skills.
Must be able to obtain and maintain U.S. Government personnel security clearance as a condition of employment.
Candidates must be authorized to work in the United States without sponsorship now or in the future.

Nice To Haves

Master's degree preferred.

Responsibilities

Oversee provider data management operations and the provider data management system, ensuring accuracy, integrity, and timeliness of provider information.
Oversee credentialing and certification operations, ensuring adherence to regulatory requirements, accreditation criteria, federal program guidelines, and internal quality standards.
Monitor, track, and report on certification and credentialing escalations to ensure timely, accurate, and compliant resolution; initiates follow-up actions and coordinates cross-functional support as needed.
Collaborate with internal teams to validate system updates, contribute to process documentation, and assist in readiness efforts for audits or accreditation reviews.
Assists in developing, compiling, and distributing routine and ad hoc reports on certification and credentialing metrics, KPIs, backlog trends, workflow timeliness, and quality indicators; contributes to presenting findings to leadership and recommending improvement strategies.
Support the development, review, and ongoing maintenance of provider communication materials, including notices, guides, templates, and FAQs, to ensure accuracy, clarity, and alignment with current provider data management, certification and credentialing requirements and organizational expectations.
Manage the shared inbox, ensuring triage, prioritization, and resolution of incoming requests, inquiries, and escalations within established service-level expectations.
Facilitate meetings with internal departments and external stakeholders to address certification and credentialing issues, concerns, or process dependencies, driving documentation and execution of agreed-upon action items.
Participate in and/or leads special projects, workflow assessments, and operational initiatives focused on enhancing credentialing efficiency, provider experience, and organizational compliance.
Serve as an internal resource and subject-matter expert on provider administration, provider data management and credentialing policies, workflows, systems, and best practices; provides guidance to team members and cross-functional partners as needed.
Other duties as assigned.