Director, Provider Data Management

Evolent Health

Arlington, VA 22212

Posted 1 week ago

Job Description

**It’s Time For A Change… Your Future Evolves Here**


Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.


Are we growing? Absolutely about 40% in year-over-year revenue growth in 2018 . Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019, and One of the “50 Great Places to Work” in 2017 by Washingtonian. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.


Evolent Health is looking for a Director, Provider Data Management Operations to join our growing Health Plan Services team. This person will play a critical role in executing and maintaining the quality of the client and vendor data received as part of each assigned initiative. The Candidate will work closely with both internal and external parties on all aspects of provider data, guiding an operational team to execute deliverables.


You will be accountable for provider data management activities relative to business rules definition, use case creation, study, quality assurance planning, client / vendor relations, and continuous improvement of data collection, mapping, exploration, transformation. You will need to be able to work well in a cross-functional and matrixed organization and be able to be both accountable to needs and thoughtful and directive in accountable and implementing the organization’s Product capabilities. You will partner closely with the IT functions and Network functions to ensure objectives and deliverables are met.


Responsibilities


+ Influence and management of provider data operational team and coordination with IT and Network management teams to execute client deliverables.


+ Coordinate data collection and promote analytics activities for specific clients to ensure timely delivery of objectives, interfacing with the client, and the Evolent team.


+ Guide the provider data gap exploration process for new clients.


+ Guide client interface for ongoing provider data operations and data updates


+ Evaluate provider related data gathered from multiple sources, reconciling conflicts while incorporating data into provider data management solution


+ Assist with defining standard data quality checks at appropriate stages to ensure all data meets requirements for operations, diagnostics and reporting.


+ Assist with documenting client specific data mapping needs, transformation rules, and any business rules related intelligence.


+ Assist in standardizing provider data management procedures such as documentation for departmental operating procedures.


+ Identify opportunities to continuously improve the data discovery and onboarding process.


+ Interface with internal and external entities to comprehend needs around data analytics and reporting.


+ Assist with quality assurance planning to ensure all provider datarequirements are satisfied


+ Act as subject matter expert for provider related data.


+ Develop and lead strategy and road map for provider data management system with capabilities that support provider data, credentialing, contract storage, pricing configuration and fee schedule management.


+ Support health plan operations in various capacities where provider data has an impact including claim processing, credentialing, contract configuration, and networkanalytics.


Qualifications


+ 10 or more years of experience in health plan operations.


+ 5 years managing a team and guiding provider data management within a Payer organization.


+ Mandatory health care information management knowledge in some combination of Provider, Payer or specialty care organizations.


Preferred


+ Masters in health, engineering or business-related discipline


+ Healthcare data and operations


+ 5 years of health plan experience in a management role in one or more functional areas of service operations required


+ Program management experience leadingcross functional teams and delivering large scale transformation programs


+ Process engineering discipline (six sigma, lean, etc.) and / orPMO certification


+ Strong client management experience, having demonstrated an ability to identify, communicate and manage risks with client executives


+ Entrepreneurial mindset geared toward the creation, execution and continuous improvement of a new employee engagement and wellness program from the ground up


+ Track record of cross functional performance in delivery of requirements analysis activities, i.e. interfacing with marketing, finance, operations, etc.


+ Strong interpersonal skills.


**Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.**



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