Sr. Manager, Provider Data and Network Operations
Core
Ensuring data accuracy and operational integrity for the Preferred Provider Network to manage outpatient Part B medical costs and support value-based care outcomes.
Role type
Senior Manager, Provider Data and Network Operations
Builds
Reliable provider/facility data pipelines, network eligibility criteria, and coverage adequacy analysis within Epic and legacy systems.
Domain
Healthcare / Value-based Care / Medicare Advantage / Network Operations
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure
Required skills
Provider/facility directory data management, SQL, data pipeline construction, vendor relationship management, cross-functional partnership, data governance, Epic system navigation
Preferred skills
Claims-based provider performance scoring, Epic referral workflows, team leadership, value-based care network management
Technologies
Epic, Snowflake, Alteryx, Dataiku
Responsibilities
Define and maintain network eligibility methodology and refresh processes; verify network coverage adequacy geographically and by insurance plan; manage provider and facility data integrity in Epic; oversee vendor partnerships for claims-based scoring and directory data; lead a small team of analysts.
Seniority
Senior, hands-on IC with team leadership
