Responsibilities

• Define and execute a multi-year strategy to improve provider operations.
• Establish and manage a portfolio of transformation initiatives across provider functions.
• Identify opportunities to improve efficiency, scalability, compliance, accuracy, and provider experience.
• Develop business cases, investment plans, and success measures.
• Design and implement operating models across provider operations functions.
• Develop workflows, governance structures, service models, and accountability frameworks.
• Simplify processes, eliminate redundancies, and improve cross-functional coordination.
• Establish sustainable operating practices that support long-term business objectives.
• Lead process redesign initiatives across Claims, Credentialing, Provider Data Management, Prior Authorization, Contracting, Delegation Oversight, and Provider Services.
• Identify root causes of operational inefficiencies, provider friction, quality issues, and compliance risks.

Requirements

• Minimum 8 years of experience in healthcare operations, business transformation, operational excellence, consulting, or related functions.
• Minimum 5 years leading large-scale cross-functional transformation initiatives.
• Experience redesigning operational processes and implementing operating model improvements that delivered measurable results.
• Experience leading complex initiatives involving multiple functions and executive stakeholders.
• Experience developing business cases, transformation roadmaps, performance frameworks, and executive presentations.
• Experience managing initiatives involving technology, operations, and organizational change.
• Medicare Advantage experience.
• Experience leading transformation, process improvement, or operational excellence functions.
• Consulting experience supporting healthcare transformation.
• Experience implementing AI, automation, digital transformation, or workflow technologies.

Preferred

• Medicare Advantage experience.
• Experience leading transformation, process improvement, or operational excellence functions.
• Consulting experience supporting healthcare transformation.
• Experience implementing AI, automation, digital transformation, or workflow technologies.
• Experience supporting rapid growth and operational scaling.
• Training in Lean, Six Sigma, Agile, Project Management, Human-Centered Design, or Change Management.
• Relevant certification in process improvement, project management, or transformation methodologies.