BZ Health Management LLC

Role Description The Director of Provider Operations is the operational owner of the provider experience across Blue Zones Health’s medical groups, delegated MSO, and RBO and IPA networks. The role carries two core accountabilities: - Running the network smoothly by reactively and proactively eliminating the operational friction that burdens providers and disrupts patient care. - Representing the network as a standing operational voice internally at BZH and externally to health plans to shape policies and practices. In a delegated managed care environment, the provider experience succeeds or fails at the operational level, i.e., whether: - Claims adjudicate correctly - Authorizations process on time - Referrals handoffs complete - Provider data is accurate - Contracts translate into what providers receive This Director was created to own it: - Resolution of issues end-to-end - Educating and communicating with providers - Maintaining the integrity of provider data and contracts - Representing the BZH network with a prepared, consistent voice Qualifications - Bachelor's degree in Healthcare Administration, Business, Nursing, or related field - 7+ years of progressive experience in healthcare operations, provider relations, managed care, or health plan/MSO/RBO/IPA administration - Demonstrated experience working across claims, utilization management, and provider-facing functions simultaneously - In-depth knowledge of medical claims processing, prior authorization workflows, and referral management in a managed care or delegated environment - Experience with RBO, IPA, MSO, and/or delegated model operations, including payer delegation requirements and oversight - Strong command of HIPAA, CMS, and applicable state regulatory requirements (e.g., DMHC, DIFS) governing provider operations and compliance - Proven ability to lead cross-functional teams and manage competing priorities in a fast-paced environment - Advanced proficiency with claims platforms (e.g., EZ-CAP, TriZetto, QNXT, Availity) and electronic health record/care management systems Requirements - Master's degree (MHA, MBA, MPH) or equivalent advanced experience (preferred) - Experience with NCQA accreditation and HEDIS measure management in a delegated environment (preferred) - Lean, Six Sigma, or equivalent process improvement certification (preferred) - Coding or billing background (CPC, CPMA, or equivalent) a plus (preferred) - Bilingual capabilities aligned with the patient/provider population served (preferred) Company Description