Director of Provider Network Management

Position Summary

The Director of Provider Network Management is responsible for the strategic development, operational oversight, and ongoing management of the organization's nationwide healthcare and veterinary provider networks.

This position provides leadership across provider recruitment strategy, network utilization, provider relations, performance management, compensation negotiations, credentialing, training, clinical policy implementation, and professional entity administration.

The Director oversees the clinician-facing operations of all service lines, including Virtual Urgent Care, Virtual Primary Care, Behavioral Health, Dermatology, Weight Management, and GoLexi Pet Telehealth.

Reporting directly to the Vice President of Clinical Operations, the Director leads network administration and provider training personnel and collaborates with Medical Directors, Clinical Advisors, and Veterinary Advisors to maintain a qualified, reliable, and high-performing provider network.

The Director serves as the primary operational leader for provider network activities, ensuring adequate coverage, operational efficiency, provider accountability, and alignment with organizational objectives.

Key Responsibilities

1. Provider Network Strategy & Utilization

• Develop and execute strategies to maintain adequate provider coverage across all states, specialties, and clinical service lines.
• Analyze consultation volume, provider availability, appointment capacity, and network utilization.
• Identify provider coverage gaps and develop strategies to address current and anticipated demand.
• Evaluate existing provider capacity before initiating additional recruitment.
• Forecast provider needs based on client growth, utilization trends, and new service implementations.
• Monitor network effectiveness and recommend improvements to optimize provider availability and operational efficiency.

2. Recruitment Strategy & DirectShifts Management

• Establish provider recruitment priorities based on network utilization, geographic coverage, specialty requirements, and business needs.
• Serve as the primary relationship manager for DirectShifts and other designated recruitment partners.
• Communicate recruitment needs, qualifications, priorities, and timelines to recruitment partners.
• Monitor recruitment pipeline activity and evaluate progress toward established recruitment goals.
• Hold recruitment partners accountable for performance expectations and deliverables.
• Coordinate with internal personnel to facilitate the transition of recruited providers into the active network.

3. Provider Relations & Retention

• Serve as the primary operational relationship contact for contracted healthcare and veterinary providers.
• Develop strategies to improve provider engagement, satisfaction, and retention.
• Address provider concerns and facilitate timely resolution of operational issues.
• Maintain proactive communication with providers regarding organizational expectations, operational changes, and service updates.
• Identify opportunities to reengage inactive or underutilized providers.
• Oversee provider departures and coordinate activities necessary to maintain network continuity.

4. Provider Performance & Adherence

• Monitor provider adherence to scheduled appointments, availability commitments, and established service-level expectations.
• Review provider no-shows, late appointments, cancellations, member complaints, and recurring performance concerns.
• Communicate directly with providers regarding performance expectations and required improvements.
• Develop and oversee corrective action plans for providers who fail to meet established standards.
• Collaborate with Quality Assurance and clinical leadership to address provider-related quality concerns.
• Maintain appropriate documentation of performance issues, corrective actions, and resolutions.
• Recommend provider suspension, restriction, or termination when warranted, subject to applicable approval processes.

5. Provider Compensation & Contract Management

• Manage provider compensation discussions, rate negotiations, and contract renewals.
• Evaluate compensation requests against approved rate schedules, specialty requirements, and network needs.
• Negotiate provider compensation within established company guidelines.
• Escalate compensation requests outside approved parameters to the Vice President of Clinical Operations.
• Monitor compensation trends and identify opportunities to improve network cost efficiency.
• Coordinate contract amendments and renewals with appropriate internal departments.
• Maintain accurate records of negotiated rates and approved exceptions.

6. Credentialing & Recredentialing Oversight

• Oversee initial credentialing and recredentialing processes for healthcare and veterinary providers.
• Ensure credentialing requirements are completed before provider activation.
• Monitor recredentialing timelines and ongoing credentialing requirements.
• Supervise personnel responsible for credentialing administration.
• Identify process delays and implement improvements.
• Coordinate credentialing concerns with the appropriate clinical leadership.
• Ensure credentialing documentation is maintained in accordance with organizational policies and applicable standards.

7. Clinical Policy, Protocol & Training Oversight

• Coordinate the development, review, and maintenance of clinical policies, provider protocols, and operational procedures.
• Collaborate with Medical Directors, Clinical Advisors, and Veterinary Advisors to ensure clinical policies are appropriately reviewed and approved.
• Oversee provider orientation, training, and ongoing education.
• Ensure providers receive current training materials, clinical guidelines, and operational resources.
• Coordinate implementation of updated clinical workflows and service requirements.
• Monitor provider adherence to approved clinical and operational protocols.
• Identify training opportunities based on provider performance, quality assurance findings, and operational trends.
• Maintain appropriate documentation of training completion and policy communications.

8. Clinical Service Line & Veterinary Network Operations

• Oversee clinician-facing operations across all healthcare and veterinary service lines.
• Evaluate provider capacity and readiness for existing programs and new service launches.
• Ensure providers have the necessary training, resources, and operational support.
• Coordinate implementation of provider-facing workflows and program requirements.
• Monitor provider participation, availability, and performance across individual service lines.
• Collaborate with clinical and veterinary advisors regarding provider education, quality concerns, and approved protocols.
• Identify operational gaps and implement corrective improvements.
• Ensure veterinary network operations support GoLexi's established consultation response expectations.

9. Professional Entity Management

• Oversee administrative management of affiliated professional entities operating across multiple states.
• Maintain records of entity registrations, annual reports, and required administrative documentation.
• Track state filing deadlines and coordinate timely submission of annual reports.
• Work with legal counsel, registered agents, and appropriate internal personnel regarding entity administration.
• Monitor entity status and proactively address administrative compliance concerns.
• Support entity formation and administrative maintenance as organizational needs evolve.

10. Team Leadership & Department Management

• Provide direct supervision to the Network Administrator, Provider Training personnel, and additional assigned network support staff.
• Establish departmental goals, performance expectations, and accountability measures.
• Oversee daily network administration and provider training activities.
• Conduct regular team meetings, employee coaching, and performance evaluations.
• Monitor departmental productivity and operational effectiveness.
• Develop and maintain departmental procedures and workflows.
• Foster effective collaboration between Network Management, Clinical Operations, Quality Assurance, Credentialing, and other internal departments.

11. Network Performance & Reporting

• Develop and maintain network performance dashboards and key performance indicators.
• Monitor provider utilization, recruitment progress, network coverage, retention, and adherence.
• Track provider availability and identify geographic or specialty-specific gaps.
• Evaluate recruitment partner performance and network development effectiveness.
• Provide regular operational updates and recommendations to the Vice President of Clinical Operations.
• Identify trends and implement strategies to improve network performance.

Qualifications

• Bachelor's degree in Healthcare Administration, Business Administration, or a related field preferred.
• Five or more years of experience in healthcare provider network management, clinical operations, provider relations, or a related field.
• Previous leadership or supervisory experience.
• Experience managing multi-state provider networks preferred.
• Knowledge of provider credentialing, recruitment, contracting, and performance management.
• Familiarity with telehealth operations and clinical service delivery.
• Strong analytical, organizational, and relationship management skills.
• Experience managing external vendors and recruitment partnerships.
• Excellent communication, negotiation, and problem-solving abilities.
• Ability to manage multiple priorities and collaborate effectively with clinical and executive leadership.