Director, Provider Data Operations

SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. Founded in 1977, SCAN has nearly five decades of experience improving care for older adults through Medicare Advantage, fully integrated care models, primary care, and next-generation care delivery.

The Job

The Director, Provider Data Operations ensures provider information is accurate, complete, timely, governed, and trusted across the enterprise. This role is responsible for the evolution of a single source of truth for provider data and enables downstream operational, regulatory, network, member-facing, and provider-facing processes with reliable provider intelligence. The Director will work cross functionally driving continuous improvement, AI-enabled automation, data quality controls, and governance practices that strengthen provider data accuracy, reduce manual effort, improve workflow efficiency, and increase confidence in internal and external provider directories.

You Will
- Lead end-to-end provider data operations, including provider hierarchy, provider records, verification, roster management, reconciliation, delegated oversight, audit readiness, issue resolution, and continuous improvement.
- Own provider data accuracy and directory integrity by establishing quality standards, validation controls, audit processes, and root-cause resolution to prevent recurring data defects.
- Drive 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.
- Ensure 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.
- Understand and implement new and future compliance requirements, navigating legislative changes and federal/state regulations.
- Direct small and medium projects and initiatives, delivering according to agreed-upon business requirements and timelines.
- Partner across Operations, Technology, Network Management, Compliance, Product, Digital, vendors, and delegated provider groups to integrate, govern, and improve provider data across enterprise processes.
- Lead implementation, optimization, and oversight of provider data applications, vendor solutions, automation, and AI-enabled capabilities.
- Monitor performance against KPIs, SLAs, quality measures, and risk indicators; translate trends into actionable insights and operational action plans.
- Establish departmental policies, practices, and procedures, and oversee document workflows and policies and procedures (P&Ps).
- Build and develop a high-performing team by setting clear goals, accountability standards, training expectations, and a culture of service, innovation, continuous improvement, and data stewardship.
- Establish staffing needs and ensure consistent training for staff through adoption of standardized processes.

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

What's in it for you?
- Base Pay Range: $147,900-$205,000, Salary
- Work Mode: Remote
- An annual employee bonus program
- Robust Wellness Program
- Generous paid-time-off (PTO)
- 11 paid holidays per year, 1 floating holiday, birthday off, and 2 volunteer days
- Excellent 401(k) Retirement Saving Plan with employer match
- Robust employee recognition program
- Tuition reimbursement
- An opportunity to become part of a team that makes a difference to members and the community every day

SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. A background check is required.