TriWest Healthcare Alliance · 2 weeks ago
Vice President, Provider Network Operations
Phoenix, AZ
Full-time
Hybrid
Director/Executive
$280K/yr - $296K/yr
10+ years expTriWest Healthcare Alliance is dedicated to serving America’s heroes by connecting them to healthcare in the community. The Vice President of Provider Network Operations is responsible for overseeing network operations, ensuring compliance with VA/DoD requirements, and fostering relationships with stakeholders to maintain and grow the provider network.
Health Care
No H1B
Security Clearance RequiredU.S. Citizen Only
Responsibilities
Oversee all fully delegated networks to ensure network adequacy requirements are consistently achieved
Oversee all credentialing processes in compliance with URAC industry standards/regulations as well as requirements prescribed per TriWest program contracts
Oversee program management of all provider network focused systems
Ensure the accuracy of all data in provider directory across all geographic areas and specialties
Lead efforts to operationalize provider data management systems
Analyze and report on the impact of change orders, control letters and other directives with implications for TriWest departments
Lead efforts to drive continuous provider satisfaction and provider relations
Oversee the development for primary source credentialing that meets defined standards
Conduct research, identify problem areas, and report on the VA/DoD network, and associated issues to TriWest senior leadership
Prepare for and meet all URAC standards for VA/DoD Health Networks
Analyze, develop, and implement continuous quality improvement process for Provider Network Management
Directly interface with shareholders and VA/DoD providers on credentialing and provider data issues
Develop and maintain production standards in Network Compliance department ensuring quality control and timely and accurate management of provider files, credentialing and contract maintenance
Monitor and manage VA/DoD network discounts levels
Performs other duties as assigned
Regular and reliable attendance is required
Qualification
Required
Master's Degree in Business, Health Care Administration, or related field or equivalent work experience
10+ years of diverse health care administration experience
5+ years of experience in Managed Care Operations
U.S. Citizen
Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
Strong health care data management experience to include provider data and associated systems
5 years of experience managing provider network credentialing programs, provider data, provider contracting, and sub-contractor management
Preferred
Experience in government programs (e.g. TRICARE, Veteran Affairs, Medicare, Medicaid)
Benefits
Medical, Dental and Vision Coverage
Paid time off
401(k) Retirement Savings Plan (with matching)
Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
Tuition reimbursement
Paid volunteer time
Company
TriWest Healthcare Alliance
TriWest Healthcare Alliance - Serving Those Who Serve. At TriWest, we honor the sacrifice and service of our nations military families by
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
unknown2025-01-30Debt Financing
Leadership Team
Mark E. Babbitt
Senior Advisor to President & CEO
Joseph Oddo
Vice President and Chief Information Officer
Recent News
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