Senior Director, Provider Data Management – Credentialing

Alignment Health

. Lead the enterprise provider data management function and establish governance frameworks supporting data quality, data stewardship, and operational excellence .

Posted 11/11/2026full-timeRemote • United StatesSenior💰 $149,882 - $224,823 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in provider data management, including governance frameworks, data quality improvement, and operational efficiency within healthcare settings. Proven ability to lead teams in credentialing operations, compliance with regulatory standards, and implementation of provider lifecycle management solutions.

Highest-signal resume keywords

Provider Data ManagementCredentialing OperationsRegulatory ComplianceOperational TransformationData Governance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Provider Lifecycle ManagementData Quality ImprovementContract ImplementationClaims OperationsNetwork ConfigurationKPI DevelopmentSLA MonitoringData StewardshipProcess OptimizationAudit Processes

Soft Skills

Analytical SkillsProblem-SolvingLeadershipCollaborationAccountability

Tools & Technologies

Credentialing PlatformsContract Management SystemsProvider Directory SolutionsWorkflow Automation SolutionsProvider Data Technologies

Certifications & Qualifications

Lean Six SigmaPMPNCQA Accreditation Knowledge

Industry Keywords

Healthcare AdministrationHealth Plan OperationsProvider ContractingRegulatory ComplianceCMS Regulations

Tech Stack

Tools & technologies

PMP

About the role

Key responsibilities & impact

Lead the enterprise provider data management function and establish governance frameworks supporting data quality, data stewardship, and operational excellence
Ensure provider demographic, credentialing, contracting, participation, reimbursement, and network data are maintained accurately across source systems and downstream platforms
Establish data ownership, controls, audit processes, and policies governing provider information throughout the provider lifecycle
Develop and monitor KPIs, SLAs, and quality metrics related to provider data operations
Drive automation, process optimization, data quality improvement, and operational efficiency initiatives
Maintain consistency and synchronization across provider systems of record, credentialing platforms, contract management systems, network configuration tools, claims platforms, provider directories, and regulatory reporting solutions
Implement controls to prevent and identify discrepancies between source systems and downstream consumers
Lead remediation of data quality issues affecting claims payment accuracy, provider directories, member access, and regulatory compliance
Oversee end-to-end credentialing and recredentialing operations for participating providers and facilities
Ensure compliance with NCQA, CMS, state regulatory, accreditation, and organizational requirements
Monitor credentialing turnaround times, inventory management, productivity, and quality outcomes
Partner with credentialing committees, medical directors, Compliance, Legal, Provider Network, Network Management, Provider Contracting, Technology, Product, Claims, Configuration, and Vendor Management teams
Ensure provider data accurately reflects executed contract terms, network relationships, participation status, contract assignments, contract IDs, rate IDs, product participation indicators, and geographic service areas
Lead teams responsible for provider data maintenance, credentialing operations, provider onboarding, roster management, and provider lifecycle management
Build scalable operational models supporting membership growth, acquisitions, new product launches, and network expansion
Direct workforce planning, organizational development, resource management, performance outcomes, and employee engagement efforts
Foster accountability, quality, transparency, and continuous improvement
Ensure readiness for NCQA, CMS, state regulatory audits, accreditation reviews, and internal compliance assessments
Oversee provider directory accuracy and provider data compliance programs
Develop corrective action plans and ensure timely implementation
Define future-state provider lifecycle management capabilities with business and technology leaders
Drive modernization involving provider data platforms, credentialing systems, workflow automation, AI-enabled operational processes, and provider directory solutions
Support business case development and vendor evaluations
Lead implementation efforts improving data accuracy, operational efficiency, provider experience, and organizational scalability

Requirements

What you’ll need

10+ years of progressive healthcare experience within a health plan environment
7+ years of leadership experience within Provider Operations, Provider Data Management, Network Operations, Credentialing Operations, or related functions
Demonstrated experience managing provider data across multiple systems and source-of-truth environments
Experience supporting contract implementation, provider network setup, contract IDs, reimbursement structures, and rate schedule management
Bachelor's degree in Healthcare Administration, Business Administration, Health Informatics, Information Systems, or related field
Deep understanding of provider lifecycle management processes and health plan operations
Extensive knowledge of provider contracting, network operations, credentialing and recredentialing, provider enrollment, provider directory management, claims operations, network configuration, and regulatory compliance requirements
Strong analytical, operational, and problem-solving capabilities
Proven ability to lead large-scale operational transformation and process improvement initiatives
Preferred: Experience with NCQA accreditation requirements and CMS regulations
Preferred: Experience implementing Provider Lifecycle Management (PLM) platforms
Preferred: Knowledge of provider master data management concepts and data governance frameworks
Preferred: Experience with provider data technologies, workflow automation solutions, and digital transformation initiatives
Preferred: Lean Six Sigma, PMP, or related operational excellence certifications