Director, Qualification Engagement

Lantern•New York, NY

16h•$160,000 - $180,000•Hybrid

About The Position

Lantern is seeking a Director, Qualification Engagement to serve as the external voice of specialist qualification on its Clinical team. Lantern’s Network of Excellence is built on the commitment that every specialist is evaluated by procedure against evidence-based clinical standards. The Clinical team establishes those standards, runs the Qualification Committee, and develops tools and processes to make qualification faster and more consistent. The Director owns how qualification is explained, decisions are delivered, and practices experience the process. This includes communicating decisions and adverse findings clearly and respectfully, explaining the review process, and providing practices with a credible explanation and a fair opportunity to respond. The role also brings clinical context to provider conversations and selected client meetings and collaborates with the Provider Network team to educate partner practices and prepare them for success. This is a Director-level individual-contributor role accountable for the qualification engagement function, with the potential to lead qualification operations staff as the function grows. Candidates may come from credentialing, medical staff services, or provider network leadership, or from a physician or other licensed-clinician background. The position is based in Dallas, TX or New York, NY, with a hybrid schedule requiring three days in the office per week. Once ramped, the expected workload is approximately 70–80% qualification and practice-facing work and 20–30% provider and client representation. Commercial representation begins after the first 90 days.

Requirements

Bachelor’s degree or equivalent professional experience.
Credibility with surgeons and practice leaders, including the ability to deliver difficult, clinically grounded decisions while maintaining relationships.
Either a clinical career as a physician or surgeon (MD or DO) or another licensed clinician, or at least 10 years of experience in medical staff services or credentialing leadership, payer provider network or provider relations management, or surgical practice or ASC administration, including clinical operations in orthopedics, spine, bariatrics, or multi-specialty surgery.
Exceptional written and verbal communication skills, including the ability to explain complex criteria without jargon or condescension and conduct difficult conversations while preserving relationships.
High emotional intelligence and judgment, with the ability to be empathetic and firm and to recognize when to listen, explain, or escalate.
Working knowledge of surgical specialties and procedures, surgical practice operations, surgeon training and credentialing, and how practice administrators, schedulers, and billing teams interact with payers and networks.
Independent problem-solving and project-management skills, including the ability to run multi-step processes, track details, and improve processes.
Comfort with data and tools, including interpreting data-driven profiles, understanding volume thresholds and outcome metrics, spotting errors, and working fluently in Microsoft 365 and modern software tools, including AI-assisted drafting with appropriate review.
Integrity under pressure and the ability to uphold standards when practices, colleagues, or commercial deadlines seek exceptions, routing such requests through the proper review process.
Experience setting strategy for a function or program and influencing senior leaders and physicians without formal authority, with readiness to build and lead a team or grow into that responsibility.

Nice To Haves

Credentialing or medical staff certification, such as CPCS or CPMSM through NAMSS, or direct experience communicating adverse credentialing or peer review determinations to physicians.
Experience building enablement or training materials for field or account teams.
For candidates from a clinical background, experience beyond direct patient care, such as medical directorship, utilization or peer review, committee or quality work, or clinical research.
Experience presenting to employer benefits leaders, consultants, or health plan audiences.
Interest in building a function from the ground up with new tooling and acting with urgency and precision when a practice or member is waiting for an answer.

Responsibilities

Deliver qualification, requalification, and standing-change decisions to practices and specialists, including approvals, procedure-level approvals, holds pending information, denials, and removals from the network.
Translate Qualification Committee reasoning into clear, accurate, clinically literate written and verbal communications that practice administrators and surgeons can act on.
Own the adverse-finding workflow by requesting documentation or clarification, tracking responses, returning complete information to the Committee, and closing the loop within defined service levels.
Respond consistently and calmly to pushback, explain decision rationales and the published guideline review process, and escalate cases to the Associate CMO when clinical judgment beyond the guidelines is required.
Maintain correspondence records so decisions and communication histories can be reconstructed and audited.
Build and maintain practice-facing explanations of the qualification process, including its seven quality domains, data sources, thresholds, and stages.
Lead qualification overview conversations with prospective and newly contracted practices, explaining requirements before groups invest effort and identifying unqualified candidates before contracting.
Set qualification guidance for Provider Success Managers so they can accurately answer first-line questions and manage routine practice relationships.
Communicate guideline changes to affected practices and specialists, including re-evaluation pathways when standards change.
Own the workflow from Committee decision through delivered communication, including letter generation from Prism, tracking, and reporting turnaround against the five-business-day target from submission to decision.
Coordinate the Qualification Committee agenda and decision record with the Clinical Quality Manager and ensure timely, clear handoffs to Network for placeability.
Capture and triage practice feedback, and define and report metrics showing whether the process is working.
Represent Clinical on provider calls requiring clinical context, including qualification questions, clinical escalation feedback, and specialist-facing quality discussions; establish criteria for when a physician leader should join.
Represent the Clinical team in selected commercial pitches and client conversations.
Set the qualification engagement function’s strategy, operating model, and service levels; build the staffing case as volume grows; and represent the function in leadership forums alongside the Clinical team.