Director, Provider Data Operations (Remote)

SCAN Group; California (MO); Remote; USD 147,900 - 205,000; Full time

Benefits offered by this job

Annual bonus program

Wellness Program

Generous PTO

11 paid holidays

401(k) with employer match

Tuition reimbursement

Remote work option

Job summary

SCAN Group is seeking a Director, Provider Data Operations to ensure accurate, timely, and governed provider information across the enterprise. You will drive a single source of truth for provider data and enable downstream processes with reliable insights.

You will lead cross‑functional teams, establish quality standards, oversee audits, and implement governance to improve accuracy, efficiency, and decision‑making while ensuring CMS and state regulatory readiness.

Qualifications

• Bachelor's Degree or 5+ years equivalent work experience.
• 2+ years of leadership experience.
• 2+ years in leading Provider Data Management teams at managed care provider organization (IPA, Medical Group or institutional provider) or insurance company.
• 5+ years of overall Healthcare experience.

Responsibilities

• Leads end-to-end provider data operations, including provider hierarchy, provider records, verification, roster management, reconciliation, delegated oversight, audit readiness, issue resolution, and continuous improvement.
• Owns provider data accuracy and directory integrity by establishing quality standards, validation controls, audit processes, and root‑cause resolution to prevent recurring data defects.
• Drives strategy and governance for provider data as a trusted enterprise source of truth, including policies, procedures, business rules, data stewardship, and alignment with downstream systems and workflows.
• Ensures regulatory and business readiness by maintaining controls that support CMS and state requirements, network adequacy, provider directory accuracy, product participation, provider terminations, and delegated oversight.
• Understands and implements new and future compliance requirements. Supports critical business strategies by providing systematic solutions and/or recommendations on business processes.
• Directs small and medium projects and initiatives. Define and deliver initiatives according to agreed‑upon business requirements and timelines.
• Partners across Operations, Technology, Network Management, Compliance, Product, Digital, vendors, and delegated provider groups to integrate, govern, and improve provider data across enterprise processes.
• Leads implementation, optimization, and oversight of provider data applications, vendor solutions, automation, and AI‑enabled capabilities that improve accuracy, efficiency, workflow performance, and decision‑making.
• Monitors performance against KPIs, SLAs, quality measures, and risk indicators; translate trends into actionable insights, recommendations, and operational action plans.
• Establishes departmental policies, practices, and procedures that have a significant impact on the organization.
• Oversees the creation of document workflows and policies and procedures (P&P) as necessary.
• Builds and develops a high‑performing team by setting clear goals, accountability standards, training expectations, and a culture of service, innovation, continuous improvement, and data stewardship.
• Establishes staffing needs and ensures consistent training for staff through adoption of standardized processes.
• We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.
• Actively supports the achievement of SCAN's Vision and Goals.
• Other duties as assigned.

Skills

Leadership experience

Healthcare experience

Education

Bachelor's Degree or 5+ years equivalent work experience

Job description

SCAN Group is seeking a Director, Provider Data Operations to ensure accurate, timely, and governed provider information across the enterprise. You will drive a single source of truth for provider data and enable downstream processes with reliable insights.

You will lead cross‑functional teams, establish quality standards, oversee audits, and implement governance to improve accuracy, efficiency, and decision‑making while ensuring CMS and state regulatory readiness.