We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only).

Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

Veterans, Reservists, Guardsmen and military family members are encouraged to apply!

Job Summary

The Director, Provider Experience is responsible for the strategic direction and operational oversight of provider experience functions across TriWest Healthcare Alliance. This role leads the development and execution of provider relationship strategies, performance standards, and quality improvement initiatives designed to establish consistency in regional operations and drive effective collaboration with corporate network operations. The Director ensures the delivery of exceptional service to providers and government stakeholders by directing cross-functional programs that enhance provider satisfaction, strengthen network engagement, and uphold contractual and regulatory compliance.

Education & Experience

Required:

• Bachelor's degree in Business Administration, Healthcare Administration, or a related field, or equivalent combination of education and experience
• 7 to 10 years of progressive experience in provider network management and provider relations within a commercial managed care environment
• 5 to 10 years of management and supervisory experience in the healthcare industry
• U.S. Citizen
• Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation

Preferred:

• Master's degree in Healthcare Administration, Business Administration, or related discipline
• Excellent communication and presentation skills
• Experience in government healthcare delivery programs (TRICARE, Medicare, etc.)

Key Responsibilities

• Provides strategic direction and oversees the implementation of provider relationship strategies, ensuring effective and timely resolution of provider issues. Directs the response to a broad range of provider inquiries related to claim status and payment, contract status, roster and data integrity, and related matters. Manages the identification of trends and the development of corrective action plans to address recurring issues. Oversees the formal provider complaint resolution team, ensuring adherence to defined metrics and timelines for resolving complaints and grievances.
• Oversees the planning, coordination, and development of programs within the Provider Services department to cultivate positive provider relationships through proactive outreach, orientation, training, and ongoing engagement. Establishes operational objectives and delegates assignments to subordinate supervisors and staff. Participates in the development, modification, and execution of operating policies. Ensures all operations meet policy and procedure performance metrics, quality assurance program standards, and applicable legal, regulatory, and contractual requirements. • Manages processes related to providers seeking to join TriWest networks, including initial provider communications, triage to contracting teams, and education on program requirements and onboarding procedures.
• Directs the identification and development of provider education programs to meet contractual requirements and positively influence provider engagement in the TRICARE and CCN programs. Oversees the creation of training materials, publications, and other provider communications. Maintains product ownership of the secure provider portal to drive engagement and self-service adoption. Implements local strategic plans to meet or exceed network performance targets. Oversees the monitoring and assessment of educational programs and emerging needs.
• Identifies opportunities and implements operational improvements pertaining to workflow procedures and service levels across key functional areas, including Customer Service and Training. Directs ongoing analysis of operational performance to support continuous process improvement, enhanced efficiency, and improved provider satisfaction through formal action plans. Facilitates the development of unit-specific quality improvement programs. • Defines personnel resource requirements and allocates staff as needed to achieve program objectives. Selects, hires, and ensures the orientation, training, and professional development of staff. Manages staff performance, conducts evaluations, and fosters career growth. Determines budgetary requirements to support program objectives and provides recommendations on the annual budget. Responsible for the implementation, control, monitoring, and evaluation of provider services to ensure compliance with all terms of agreement.
• Collaborates cross-functionally with other departments to support continuing quality improvement, providing input on claims processing issues, provider management matters, change orders, and program updates. Facilitates the group's integration with and support of the provider service delivery model.
• Monitors and reports on key performance indicators, provider satisfaction metrics, and operational dashboards to inform leadership decision-making and drive accountability across the provider experience function.
• Regular and reliable attendance is required.

Competencies

Coaching / Training / Mentoring: Actively develops the skills and capabilities of direct reports and extended team members through constructive feedback, mentoring relationships, and structured development opportunities aligned with business outcomes.

Communication / People Skills: Ability to communicate effectively across all levels of the organization and with external stakeholders including providers and government partners. Adapts communication style to the audience; listens critically; presents complex information clearly and persuasively in both written and verbal formats.

Computer Literacy: Proficiency in a multi-system Microsoft environment including Word, Excel, Outlook, PowerPoint, and SharePoint. Comfortable navigating TriWest's Intranet, provider portal platforms, and department-specific software applications.

Coping / Flexibility: Resiliency in adapting to evolving business requirements, shifting priorities, and diverse stakeholder expectations while maintaining composure and a solutions-oriented mindset.

Independent Thinking / Self-Initiative: Critical thinker with the ability to look beyond day-to-day operations and focus on what matters most to achieving long-range organizational outcomes. Evaluates market trends, program requirements, and stakeholder needs to develop strategic plans that drive provider engagement and network performance. Demonstrates commitment to producing results without close direction and resourcefulness in identifying the tools, information, and cross-functional partnerships needed to succeed.

Information Management: Ability to manage, interpret, and leverage large volumes of operational data, provider metrics, and program information to support informed decision-making. Ensures accuracy, confidentiality, and appropriate dissemination of sensitive information.

Leadership: Demonstrates the ability to lead, motivate, and develop diverse teams. Provides clear strategic direction, sets performance expectations, and holds staff accountable while fostering an inclusive and high-performing work environment. Takes full ownership of departmental results, budget stewardship, and compliance outcomes. Proactively identifies risks, escalates issues appropriately, and drives resolution to completion. Effectively manages through change and ambiguity.

Multi-Tasking / Time Management: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and a mature problem-solving approach. Effectively prioritizes competing demands to meet critical deadlines.

Organizational Skills: Demonstrates the ability to manage multiple competing priorities, programs, and deadlines simultaneously. Establishes clear processes, delegates effectively, and maintains focus on deliverables across a complex operational environment.

Problem Solving / Analysis: Ability to diagnose complex operational and provider-related issues through systematic analysis of processes, data, and stakeholder feedback. Exercises sound judgment in evaluating alternatives and implementing effective solutions.

Team-Building / Team Player: Builds cohesive, high-functioning teams through trust, collaboration, and shared accountability. Fosters a culture of mutual respect and cross-functional partnership to achieve departmental and organizational objectives.

Technical Skills: Proficiency in leveraging healthcare management systems, provider portal platforms, and data reporting tools to drive operational performance and informed decision-making. Demonstrates the ability to interpret and utilize claims data, provider metrics, and program analytics to identify trends, measure outcomes, and support continuous improvement. Comfortable navigating HRIS platforms, CRM systems, and business intelligence tools in a complex, multi-system environment.

Working Conditions

Working Conditions:

• Favorable working conditions in a climate-controlled office space
• Must be able to travel (locally or distant with overnight stays) a minimum of ten (10) percent and a maximum of fifty (50) percent of the time
• Must be able to work under stressful conditions
• Must be able to obtain appropriate DITSCAP security clearance

Company Overview

Taking Care of Our Nation's Heroes.

It's Who We Are. It's What We Do.

Do you have a passion for serving those who served?

Join the TriWest Healthcare Alliance Team! We're On a Mission to Serve®!

Our job is to make sure that America's heroes get connected to health care in the community.

At TriWest Healthcare Alliance, we've proudly been on that important mission since 1996.

DoD Statement

Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

Benefits

We're more than just a health care company. We're passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:

• Medical, Dental and Vision Coverage
• Paid time off
• 401(k) Retirement Savings Plan (with matching)
• Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
• Tuition reimbursement
• Paid volunteer time

TriWest job postings typically include a salary range, which can vary based on the specific role and location, but generally this position ranges from around $161, 000 to $178, 000 per year.

Equal Employment Opportunity

TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.