Senior Director, Network Operations

L.A. Care Health Plan•Los Angeles, CA

1d•$206,311 - $350,729•Onsite

About The Position

This Senior Director, Network Operations oversees network operations to ensure efficiency, effectiveness, and alignment with Health Plan strategies and regulatory requirements. Develops strategic plans, drives change and influences critical business outcomes. Responsibilities include identifying operational gaps and provider pain points, implementing process improvements, and developing performance reporting for leadership visibility. Leads regulatory implementation by translating mandates into practical workflows and communications, partnering with Compliance, Legal, and other stakeholders to ensure requirements are tracked, assessed, and effectively operationalized. It provides strategic oversight for managed care programs, establishing workflows, controls, and reporting for initiatives such as Targeted Rate Increases and Hospital Directed Payments. The role manages provider communications and maintains the Universal Provider Manual, ensuring accuracy and compliance. This position is responsible for directing all aspects of running a high-performance and efficient team, including hiring, supervising, coaching, training, disciplining, mentors and motivating direct reports. Represents the Health Plan in external forums and drives organizational excellence and stakeholder engagement.

Requirements

At least 10 years of progressively responsible experience in managed care, health plan operations, provider network operations, regulatory implementation, or related healthcare functions.
At least 10 years of leading staff, supervising staff and/or people management experience.
At least 5 years overseeing professional teams, complex programs, cross-functional initiatives, and enterprise-level operational deliverables.
Experience leading teams, projects, initiatives, or cross-functional groups.
Demonstrated experience in leading the operational implementation and ongoing administration of managed care programs, translating program requirements into effective workflows, business rules, policies, controls, and measurable outcomes.
Significant experience in reviewing, interpreting, and operationalizing regulatory requirements, including All Plan Letters (APLs), policy guidance, and contractual directives is essential.
Strong experience administering or providing operational oversight for provider-directed payments, supplemental payment programs, incentive programs, and other government-sponsored initiatives, with proven coordination across Finance, Claims, Configuration, Compliance, and other stakeholders.
Experience coordinating complex initiatives, developing and monitoring operational performance measures, identifying operational gaps, managing concurrent regulatory and operational priorities, and executing provider communications, including provider portal management is required.
Expert knowledge in Medi-Cal managed care contract requirements, including the ability to interpret and operationalize contract terms to ensure compliance and operational excellence.
Expert knowledge of All Plan Letter (APL) implementation is essential, enabling the translation of regulatory guidance into actionable workflows and controls across the provider network.
Strong knowledge of network adequacy standards, with proven ability to analyze provider data, identify gaps, and implement corrective actions to maintain regulatory compliance.
Excellent verbal, presentation and written communication skills are critical, including the development and management of notices, bulletins, manuals, and other materials tailored for diverse audiences such as hospitals, medical groups, ancillary providers, and health systems.
Knowledge of regulatory audit processes is required, including preparation, documentation, process review, and post-audit remediation.
Strong collaboration skills with cross functional groups and key stakeholders is essential to ensure audit readiness and successful outcomes.
Knowledge of delegated provider organizations and a variety of provider types, including hospitals, health systems, medical groups, and ancillary providers.
Ability to navigate complex relationships, coordinate operational requirements, and ensure alignment across external partners is key to success in this role.
Demonstrated ability to think long-term and develop strategies that align with the overall goals of the organization.
Demonstrated ability to make sound and timely decisions.
Demonstrated ability to adapt to changing situations and adjust strategies accordingly
Demonstrated ability to adapt to a fast-paced and evolving environment and to lead others through change.
Excellent interpersonal skills for building relationships, fostering teamwork, and creating a positive work environment.
Excellent ability and knowledge in analyzing data, identifying problems, and making informed decisions, often in complex or ambiguous situations.
Travel to offsite locations for work required.

Nice To Haves

Master's Degree
At least 12 years of healthcare experience, ideally within large, complex managed care organizations serving diverse products, populations, and provider types.
Direct experience with Medi-Cal managed care regulatory requirements and state-issued guidance is highly valued.
Ability to successfully develop and implement enterprise operating models, governance structures, standardized playbooks, and performance management frameworks.

Responsibilities

Drives the execution and oversight of network operations, ensuring alignment with Health Plan strategies and regulatory requirements.
Conducts strategic planning to utilize resources to meet current and future departmental and Enterprise-wide goals.
Manages budgets and resources effectively.
Identifies operational gaps and provider pain points, translating them into process improvements that enhance provider experience, operational efficiency, compliance, and network performance.
Convert strategic priorities into actionable operating plans with clear milestones, resource allocation, risk management, and measurable outcomes.
Develops performance reporting to provide leadership with visibility into operational effectiveness and emerging risks.
Identifies and drives change initiatives.
Implement and operationalize actionable regulatory requirements.
Leads the operationalization of regulatory and contractual requirements, translating complex federal and state mandates into practical workflows, controls, technology solutions, and provider communications.
As a primary operational partner to Compliance, Legal, and other stakeholders, the position establishes regulatory stewardship, tracks requirements, assesses impacts, manages implementation milestones, and monitors post-implementation effectiveness.
Ensures regulatory changes are reflected in provider-facing materials and coordinates remediation for identified gaps.
Provides strategic oversight and operational execution for managed care programs, requiring cross-functional collaboration and establishing workflows, controls, timelines, and reporting.
Oversees programs such as Targeted Rate Increases, Hospital Directed Payments, and other supplemental or state-directed payment initiatives.
Responsibilities include translating program requirements into operational activities, ensuring eligibility, payment accuracy, provider communications, and executive reporting on program performance and financial impact.
Develop and implement communication strategies.
Establishes and manages the Health Plan’s provider communication strategy, partnering with Communications, Compliance, Legal, and Network Leadership.
Develops standards for provider notices, newsletters, portal announcements, and owns the content and publication strategy for the Universal Provider Manual, ensuring information is accurate, current, and compliant.
Conducts strategic planning to maximize the utilization of resources to meet current and future departmental and Enterprise-wide goals.
Manages department budget(s).
Leads discussions on policy operationalization and oversee key policy perspective sharing.
Identifies and actualizes enhancements to support company vision.
Identifies and drives change initiatives.
Collaborates with cross-functional teams to achieve common goals.
Develops and maintains relationships with key stakeholders.
Represents the company or organization in external interactions, such as provider meetings, community forums, and strategic partnerships, driving organizational excellence and stakeholder engagement.
Develops goals, objectives and actions plans for assigned staff which includes full management responsibility for the hiring, performance reviews, salary reviews and disciplinary matters for direct reporting employees.
Leads and mentors a high-performance network operations team, fostering accountability and process simplification.
Performs other duties as assigned.