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Commonwealth Care Alliance Director, Provider Data Management in Boston, Massachusetts

The Director, Provider Data Management (PDM) is responsible for the leadership and management of the provider data operational team to execute deliverables. They play a critical role in executing and maintaining the quality of provider data; working directly with internal and external parties on all aspects of provider data.

  • Identify opportunities to continuously improve the data and provider onboarding process.

  • Develop and lead strategy and road map for provider data, management system with capabilities that support provider data, organizational structures (hierarchy), credentialing data, contract storage, pricing configuration and fee schedule management.

  • Responsible for provider data management activities relative to requirements and business rules definitions, use case creation, analysis, quality assurance planning, provider and vendor relations, and continuous improvement of data collection, mapping, analysis, and transformation.

  • Work well in a cross-functional and matrixed organization and be able to be both responsive to needs and thoughtful and directive in supporting and implementing the organization’s provider data requirements.

  • Partner closely with the IT and Network functions to ensure objectives and deliverables are met.

  • Interface with internal and external entities to understand needs around data analytics and reporting.

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

  • Assist with documenting CCA’s specific data mapping needs, transformation rules and any business rules related to intelligence.

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

  • Act as a subject matter expert for provider related data.

  • Develops functional specifications, the design of detailed flow charts of systems applications and confers with technical personnel in systems analysis and application planning.

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

  • Establish internal and external department communications and team building.

  • Submits monthly reports timely, meets projects deadlines, and provides timely follow-up to internal and external customers.

  • Maintains and meets productivity and performance standards for all activities for successful program execution

  • Monitors and reports key metrics of department performance for productivity and quality, as appropriate.

  • Plays a critical leadership role defining automation opportunities for provider data management both through self service capabilities as well as those required internally during integration across systems.

  • Prepares and oversees departmental budget.

  • Provides leadership to establish a positive work environment that encourages employee participation in process improvement and commitment to department/company success.

  • Evaluates productivity and performance reports and data for the purposes of reporting, providing employee feedback and determining changes necessary to improve performance.

  • Ensures process changes are developed when necessary, training is provided, processes are implemented and results support department success.

  • Directs hiring and training of department managers, supervisors, and other staff. Manages turnover.

  • Ensures timely performance feedback and opportunities for development.

  • Designs and participates in programs to foster an environment of employee growth and opportunity.

  • Develops and implements strategies to simplify processes and decrease administrative costs.

  • Master’ degree in health, engineering or business-related field preferred. Bachelor’s degree in a related area required..

  • 5-8 years of experience in health plan operations, specifically working with provider data management systems and their design, configuration, and data loading procedures.

  • 2-3 years of SQL experience- focused on query development, basic analysis capabilities.

  • 5 years managing a team

  • 5 years leading a complex operations environment including managing in a production environment and leading operational improvement.

  • Experience with healthcare provider data.

  • Proven track record of developing, monitoring and managing to performance metrics.

  • Well-developed planning capabilities with a track record of achieving results, controlling costs, setting budgets and meeting deadlines.

  • Ability to think critically, drive change and influence individuals at all levels of the organization and to take appropriate risks.

  • Program management experience leading cross functional teams and delivering large scale transformation programs.

  • Proven track record in establishing strong relationships with providers and vendors.

  • Excellent written, computer and oral communication skills.

  • Strong leadership and interpersonal skills.

ID: 2020-3373

External Company Name: Commonwealth Care Alliance, Inc.

External Company URL:

Actual Work Location: Lafayette City Center, Boston, MA