Remote Director, Preferred Networks & Care Routing

Care Routing Strategy & Preferred Network Design

Design and lead the enterprise care routing strategy, aligning provider selection and referral pathways with organizational goals for quality, affordability, access, and member experience.
Define and maintain preferred network frameworks that segment providers based on performance, capacity, access, and clinical outcomes.
Establish clear, data-driven criteria for identifying high-performing providers while ensuring adequate access for members across geographies and specialties.
Partner with Network Management to inform network strategy, provider engagement priorities, and prospective network development.

Network Intelligence & Member-Centric Network Adequacy

Own the development of network intelligence capabilities that integrate claims, utilization, clinical outcomes, access, and member demand data.
Evaluate network adequacy beyond regulatory compliance measures, assessing whether the network meaningfully meets member needs related to access, capacity, timeliness, specialty coverage, and care continuity.
Identify gaps, redundancies, or misalignments in the network that may impact care routing effectiveness or member experience.
Provide data-driven recommendations to adjust network composition, provider mix, or geographic coverage based on performance and access insights.
Partner with Compliance and Network teams to ensure alignment between regulatory adequacy requirements and operational network realities.

Workflow Design & Operational Integration

Design and embed care routing workflows within existing operational teams (e.g., UM, Care Management, Member Services, Provider Relations, Scheduling) to steer members to preferred providers while preserving access and choice.
Identify high-impact scenarios where proactive or facilitated care routing is required and develop scalable workflows to support those needs.
When appropriate, establish and lead a small team to directly facilitate care routing for targeted populations, services, or workflows.
Ensure care routing logic is operationally feasible, clinically appropriate, and supported by tools, data, and clear handoffs.

Cross-Functional Leadership & Strategic Influence

Serve as the enterprise owner for care routing, preferred networks, and member-centric network adequacy strategy.
Influence enterprise decisions related to network design, access standards, clinical programs, and value-based care initiatives using network and performance insights.
Partner with Clinical, Quality, UM, Analytics, and Compliance leaders to align care routing with clinical appropriateness, regulatory expectations, and operational capabilities.
Support change management efforts to drive adoption of care routing strategies across teams and provider-facing functions.

Team Leadership & Capability Building

Build, lead, and develop a small, high-performing team focused on network intelligence, care routing execution, and network adequacy analysis.
Establish clear performance goals, metrics, and accountability for the team.
Foster a culture of continuous improvement, collaboration, and data-driven decision-making.