Provider Network Operations Director (Remote-NC)

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Provider Network Operations Director in North Carolina (USA). This leadership role is responsible for directing and optimizing the provider network operations to ensure access, quality, and compliance for members with specialized healthcare needs. The Director will oversee enrollment, credentialing, contracting, and network development while collaborating across departments to meet regulatory, accreditation, and organizational goals. This position offers the opportunity to shape network strategy, enhance provider relationships, and implement process improvements that impact patient care and operational efficiency. Ideal for professionals who thrive in a collaborative, mission-driven environment with both strategic and hands-on responsibilities. \n

Accountabilities Develop and implement operational strategies, policies, and procedures that align with organizational goals, accreditation standards, and contractual requirements. Lead provider enrollment, credentialing, and contracting processes to ensure a qualified and compliant network. Oversee provider data management, network adequacy reporting, and technical workflows to support regulatory and operational standards. Collaborate with cross-functional teams to assess service capacity, identify gaps, and develop Requests for Proposals (RFPs) to expand and optimize the provider network. Provide leadership, mentorship, and performance management for the provider network operations team, ensuring staff are trained, supported, and aligned with organizational objectives. Facilitate provider dispute resolution, stakeholder engagement, and consumer/family collaboration to enhance network effectiveness and satisfaction. Ensure compliance with state, federal, and accreditation standards, including Medicaid Transformation, Tailored Plans, and Managed Care regulations. Requirements Bachelor’s degree in mental health, public health, social work, psychology, education, sociology, business, or public administration; Master’s degree preferred. Minimum of 5 years’ experience in community, governmental, or healthcare programs, including provider network operations and management. At least 3 years’ supervisory, consultative, or administrative experience. Strong knowledge of mental health, substance use, and intellectual/developmental disability service systems. Understanding of Medicaid, Local Management Entities, Managed Care, and accreditation standards (NCQA). Excellent leadership, problem-solving, negotiation, and conflict resolution skills. Strong communication, public speaking, and interpersonal skills to manage stakeholders and facilitate collaboration. Proficiency with Microsoft Office Suite and data analysis for program evaluation. NC residency required and ability to travel as needed. Benefits Competitive compensation with annual incentive bonus plan. Medical, dental, and vision insurance with low deductible options. Generous vacation, sick time accrual, and 12 paid holidays. State retirement/pension plan and 401(k) with employer match. Company-paid life and disability insurance. Wellness programs and public service loan forgiveness eligibility. Flexible work location options within North Carolina with remote capabilities.

\n Jobgether is a Talent Matching Platform that partners with companies worldwide to efficiently connect top talent with the right opportunities through AI-driven job matching. When you apply, your profile goes through our AI-powered screening process designed to identify top talent efficiently and fairly. 🔍 Our AI evaluates your CV and LinkedIn profile thoroughly, analyzing your skills, experience, and achievements. 📊 It compares your profile to the job’s core requirements and past success factors to determine your match score. 🎯 Based on this analysis, we automatically shortlist the three candidates with the highest match to the role. 🧠 When necessary, our human team may perform an additional manual review to ensure no strong profile is missed. The process is transparent, skills-based, and free of bias — focusing solely on your fit for the role. Once the shortlist is completed, we share it directly with the company that owns the job opening. The final decision and next steps (such as interviews or additional assessments) are then made by their internal hiring team. Thank you for your interest!

By submitting an application to this posting, the applicant acknowledges that Jobgether will process their personal data as necessary to evaluate their candidacy, provide feedback, and, when appropriate, share relevant information with potential employers. Such processing is carried out on the basis of legitimate interest and pre-contractual measures in accordance with applicable data protection laws. The applicant may exercise their rights of access, rectification, erasure, and objection at any time as provided under the GDPR.

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