Healthcare Network Operational Director

TPIS

6d

About The Position

This position is responsible for leading the operational execution of initiatives within the Network Management area, ensuring that projects related to operational efficiency and regulatory compliance are successfully implemented from start to finish.

Requirements

• Master’s degree in Public Health, Health Services Administration, Business Administration, or a related field.
• Minimum of five (5) years of experience in: Healthcare regulatory compliance Operational process optimization
• Experience leading performance improvement initiatives in complex, highly regulated health insurance environments.
• Minimum of two (2) years of supervisory experience.
• Bachelor’s degree in Public Health, Health Services Administration, Business Administration, or a related field.
• Minimum of seven (7) years of experience in: Healthcare regulatory compliance, or Operational process optimization
• Experience leading performance improvement initiatives in complex, highly regulated health insurance environments.
• Minimum of four (4) years of supervisory experience.
• Knowledge of audit practices, corrective action plans, and compliance monitoring within healthcare operations.
• Knowledge of data quality standards and best practices for maintaining accurate and audit-ready records.
• Spanish – Advanced
• English – Advanced

Nice To Haves

• Project Management Professional (PMP)
• Lean Six Sigma

Responsibilities

• Lead operational efficiency and regulatory compliance projects within the department, ensuring initiatives are delivered within scope, timeline, and established regulatory requirements, and achieve expected performance outcomes.
• Provide strategic guidance to the Enterprise Project Management Office (EPMO) and other departments by aligning internal and external stakeholders, clarifying priorities, resolving dependencies, and ensuring disciplined and effective execution of Network Management projects.
• Monitor initiative performance, identify risks and mitigation plans, and prepare and present status reports, dashboards, and recommendations to senior and executive leadership forums.
• Oversee and continuously optimize contracting and credentialing operational processes, supporting provider network adequacy, improving turnaround times (TAT), and increasing operational effectiveness.
• Support management in operational and regulatory initiatives by providing operational analysis, impact assessments, and execution support as needed.
• Assist with departmental audits and regulatory readiness activities, ensuring accurate documentation, timely responses, and effective implementation of corrective action plans.
• Establish, monitor, and report key performance indicators (KPIs) and service level agreements (SLAs) to evaluate operational performance, identify gaps, and drive continuous improvement initiatives.
• Ensure the integrity, accuracy, and audit readiness of provider network information through data quality controls and standardized operational practices.
• Develop and maintain standardized operational documentation, including standard operating procedures (SOPs), process maps, and workflow guides to ensure consistent and compliant execution across teams.

What This Job Offers

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