Director of Network Operations

Spartanburg Regional Healthcare System • Spartanburg, SC

4d

About The Position

The Director of Network Operations is a leadership role responsible for strengthening Regional HealthPlus (RHP)’s provider network operations in support of RHP’s work as Spartanburg Regional Healthcare System (SRHS)’s clinically integrated network (CIN/PHO). The position ensures the network is positioned to succeed across fee-for-service and value-based contract arrangements by leading provider operations connecting payors, SRHS-owned facilities and providers, and aligned non-owned facilities and providers. The Director builds trusted relationships with network stakeholders, facilitates performance improvement initiatives, and coordinates with subject matter experts to deliver measurable results. The role requires collaboration, strong project management, clear communication, and broad experience in payor-facing and provider-facing operations.

The Director oversees provider engagement and network composition, effectiveness, and strategic alignment; maintains payor relationships and supports operationalization of alternative payment models; and manages value-based care and episodic payment performance activities. The role also supports administration and performance oversight of the SRHS Employee Health Plan, including its provider network, reporting, medical management, utilization review, and direct contracting arrangements. The Director leads cross-functional projects and supports relevant committees, workgroups, and strategic initiatives.

Requirements

• Bachelor’s degree in healthcare administration, business administration, or a related field.
• Minimum of eight years of progressive experience in healthcare, health plan, managed care, or provider network operations roles.
• Significant cross-functional experience leading collaborative projects and operational initiatives across multiple stakeholders.
• Demonstrated leadership, team-building, and relationship management skills.
• Strong knowledge of provider network operations.
• Strong understanding of health insurance, managed care contracting, and value-based care models.
• Familiarity with provider credentialing and payor enrollment/load processes.
• Strong organizational, verbal, and written communication skills.
• Strong working knowledge of MSSP program requirements, benchmarking methodologies, and accountable care operations.
• Subject matter expertise in episodic care models, including bundled payment models, and other alternative payment models.

Nice To Haves

• Master’s degree.

Responsibilities

• Oversee the composition, effectiveness, and strategic alignment of the RHP provider network, including provider access, network adequacy, provider assignment and attribution, network integrity, and improvement recommendations.
• Recruit, onboard, and retain strategically aligned providers and facilities within the RHP network.
• Oversee participating provider membership and related operational processes.
• Ensure timely, professional, and well-documented communications to RHP providers about network strategy and provider engagement priorities.
• Provide independent participating providers with managed care operational support, including staff education, payor in-service meetings, and escalated claims resolution as needed.
• Monitor market and industry trends affecting provider network composition, access, adequacy, and strategic alignment.
• Coordinate implementation of performance improvement initiatives across network providers and stakeholders, including employed and non-employed providers, hospitals, ambulatory surgery centers, skilled nursing facilities, and other participants.
• Maintain working relationships with payor representatives to support collaboration, operational alignment, and timely issue resolution.
• Lead reconciliation of provider assignment and patient attribution rosters between payors and providers to improve operational accuracy, performance measurement, and financial outcomes.
• Collaborate with payors and internal stakeholders to operationalize bundled payments and other alternative payment models, including the South Carolina Healthy Connections Quality Achievement Program (QAP).
• Lead network-wide operational improvement initiatives as needed, involving independent provider interoperability, reporting, CMS innovation models or pilots, and other strategic initiatives.
• Oversee RHP delegated credentialing agreements with payors and ensure compliance with contractual, regulatory, and audit requirements.
• Collaborate in a matrixed environment to resolve payor provider directory and claims system upload issues, improving accuracy, timeliness, provider access, and network integrity.
• Monitor performance and identify drivers of variation, including utilization patterns, cost of care, post-acute spending, and quality outcomes.
• Coordinate operational readiness and implementation activities to support contractual performance objectives.
• Help ensure population health programs are scalable, measurable, and integrated into routine clinical and practice operations.
• Support contractual and financial reconciliation processes related to bundled payment programs and other alternative payment models.
• Drive development of dashboards, scorecards, and performance monitoring tools for episodic care and other alternative payment models.
• Support administration of the SRHS Employee Health Plan, including provider network contracting, operations, and associated reporting.
• Collaborate with Human Resources, healthcare consultants, the third-party administrator (TPA), and pharmacy benefit manager (PBM) on plan operations, performance, and strategic initiatives.
• Lead development of employee health plan performance reporting for operational oversight, decision-making, budget forecasting, and ongoing improvement.
• Lead the medical management and utilization review team in support of plan performance, appropriate utilization, and care management objectives.
• Oversee direct contracting arrangements and associated reporting for the SRHS Employee Health Plan.
• Lead and coordinate cross-functional projects related to network operations, value-based care contracts and alternative payment model performance, employee health plan performance, and other strategic initiatives.
• Provide administrative leadership and operational support for the Membership and Participation Committee.
• Participate in selected RHP, SRHS, and SEHP committees and workgroups to support network operations and strategic initiatives.
• Represent RHP in collaborative efforts with internal SRHS departments, non-owned providers, and other provider and administrative stakeholders.
• Coordinate with Southeastern Health Partners and other strategically aligned partners on shared network, operational, and strategic initiatives.
• Coordinate with the Provider Engagement and Performance Committee in support of the provider disciplinary process, as needed.
• Support departmental planning, prioritization, and execution of key operational and strategic initiatives.
• Perform other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Director