Sr Director, Provider Data Management

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do.

Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults.

Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity.

At SCAN, we believe scale should strengthen—not dilute—our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve.

About SCAN

SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation’s leading not-for-profit Medicare Advantage plans, serving more than 300,000 members in California, Arizona, Nevada, New Mexico, Washington and Texas. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn; Facebook; and Twitter.

The Job

The Sr. Director, Provider Data Management will supervise and direct the loading and timely maintenance of provider data within the core systems. Works in partnership with internal and external stakeholders, as well as vendors, to ensure the precision of provider data in provider directories and internal systems. Assumes the responsibility of designing the provider data framework to align with the company's expansion and growth initiatives. Ensures adherence to all compliance and regulatory requirements concerning provider data and maintains adherence to SLAs.

You Will

Establishes policies and procedures governing the collection, storage, and retrieval of multiple data types taken from disparate sources. Develops quality standards and validation processes to ensure accuracy and integrity of organizational data based on guidelines set by project stakeholders or requirements of downstream systems.

Oversee all provider data accuracy verification process including quarterly verifications and adopt to new business rules as required by business needs. Audit delegated medical groups providers data periodically and asses and report any risks with their data. Oversee implementation and maintenance of vendor applications for provider data maintenance and accuracy verifications. Supports key operational strategic initiatives with a focus on systems and processes. The Director, Provider Data Management will ensure that vendors comply with the Key Performance Indicators (KPIs) established for provider data quality by consistently monitoring and verifying their adherence to these standards.

Acts as a liaison between the end-user of the data and the data storage/management architecture team to ensure that functional requirements are technologically feasible and resulting systems meet user needs. Leads and directs the work of other employees and has responsibility for personnel actions including hiring, performance management, and termination. Supervision is often provided through a team of subordinate managers. Contributes to strategic planning, direction, and goal setting for the department or function in collaboration with senior management. Establishes departmental policies, practices, and procedures that have a significant impact on the organization.

Provide leadership and guidance to the team in order to generate innovative process improvements that effectively address emerging business challenges. Additionally, offer mentorship to team members to facilitate their professional development and enhance their problem-solving capabilities. Maintains a formal process for proactively determining and ensuring the SCAN provider network meets CMS and state requirements. Understand and implement new and future compliance requirements. Direct small, medium and large projects and initiatives. Partner with cross functional teams to define and deliver solutions according to agreed-upon business requirements and timelines.

Ensures the maintenance of organizational, departmental, federal, and state-specific standards, while also achieving and sustaining accuracy in overall provider processing. Responsible for architecting the provider hierarchies to meet the business growth and expansion needs.

Accomplish staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching and counseling employees; initiating, coordinating, and enforcing systems, policies, and procedures. Motivates and maintains staff by recruiting, selecting, orienting, and training employees; maintaining a safe and secure work environment; developing personal growth opportunities. Proactively identify opportunities for process improvements. Make recommendations to appropriate stakeholders and actively manage through project delivery. Direct small, medium and large projects and initiatives. Partner with cross functional teams to define and deliver solutions according to agreed-upon business requirements and timelines. Build strong collaborative relationships with internal and external stake holders and perform at an organizational level.

The Director, Provider Data Management will oversee Provider Data Management and Provider Data quality teams and ensure they meet all SLAs.

Establishes staffing needs and ensures consistent training for staff through adoption of standardized processes.

Supports critical business strategies by providing systematic solutions and or recommendations on business processes. Proficient in navigating legislative changes, federal and state regulations, to direct teams to make necessary changes. Supports critical business strategies by providing systematic solutions and or recommendations on business processes.

Oversee the creation of document workflows and policies and procedures (P&Ps) as necessary. Ensure updates (adds, changes, and terminations) for new or existing provider records are made per Health Plan Service Level Agreements (SLAs). Responsible for data accuracy on internal and external provider directories.

We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.

Actively support the achievement of SCAN’s Vision and Goals.

Other duties as assigned.

Your Qualifications

Bachelor’s Degree or 7+ years of equivalent experience

5+ years of leadership experience

4+ years in leading Provider Data Management teams at managed care provider organization (IPA, Medical Group or institutional provider) or insurance company.

7 + years of overall Healthcare experience.

Ability to foster teamwork. Leadership skills. Ability to drive strategic direction. Oral and written communication skills. Ability to build collaborative relationships. Analytical thinking skills. Technical expertise. Detail oriented. Project management skills.

Complete understanding for CMS and DHCS requirements for provider data maintenance and directories is required.

Familiar with a variety of the Medicare and Medicaid's concepts, practices, and procedures. Strong interpersonal skills, including excellent written and verbal communication skills.

Strong organizational skills. Consistently demonstrates self-motivation, integrity, initiative and innovation in achieving results.

Strong communication (written and verbal), influencing, negotiating, listening and interpersonal skills to effectively develop productive internal and external relationships. Strong presentation skills to effectively address diverse audiences.

Ability to multitask. Ability to appropriately maintain confidentiality. Project management skills and supervisory experience.

What's in it for you?

• Base Pay Range: $177,500-$244,648, Salary

• Work Mode: Mostly Remote

• An annual employee bonus program

• Robust Wellness Program

• Generous paid-time-off (PTO)

• 11 paid holidays per year, 1 floating holiday, birthday off, and 2 volunteer days

• Excellent 401(k) Retirement Saving Plan with employer match

• Robust employee recognition program

• Tuition reimbursement

• An opportunity to become part of a team that makes a difference to our members and our community every day!

We're always looking for talented people to join our team!  Qualified applicants are encouraged to apply now!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)