Senior Director, Strategic Client & Network Operations

Company Overview: Emboss Specialty partners with health plans to simplify specialty care delivery, improve clinical and financial performance, and create a better experience for members, providers, and clients.

Emboss Specialty is a value-based specialty management company that operates like a health plan within a health plan. We help plans improve performance across specialty care and therapeutics management through provider engagement, clinical expertise, and operational excellence, delivering better outcomes, regulatory confidence, and savings of up to 30%.

Position Summary:

The Senior Director, Strategic Client and Network Operations is the senior Network leader accountable for the dedicated key health plan client relationship and for enterprise network initiatives that require executive coordination, disciplined governance, analytics, and cross-functional execution. The role serves as the client’s primary senior Network partner while also operating as a strategic extension of the EVP, Value-Based Networks across client health, network performance, financial planning, reporting, provider operations, and transformation priorities.

This leader converts payer, provider, and executive priorities into clear workplans, decisions, owners, and measurable outcomes. The role integrates client partnership responsibilities with the strategic operating work previously performed through Network Operations and Chief of Staff support, ensuring that high-priority initiatives do not stall between Network, Analytics/BI, Finance, Legal, Credentialing, Operations, Technology, and specialty leaders.

The position is designed for an executive who can move fluidly between external client leadership and internal enterprise execution. The client remains a dedicated priority; available capacity will be directed to the highest-value Network initiatives established by the EVP, Value-Based Networks.

Scope and Operating Model

• Dedicated senior Network relationship owner for the client across specialties, products, markets, access, contracting, implementation, performance, complaints, and growth priorities.

• Enterprise leader for Network Operations and shared-services capabilities, including repeatable workflows supporting contracting, credentialing and onboarding, training, provider support, analytics, and cross-segment execution.

• Enterprise lead for strategic Network initiatives requiring coordination across clients, specialties, analytics, finance, technology, operations, and provider-facing teams.

• Executive owner of operating cadence, portfolio visibility, prioritization, escalation, and follow-through for assigned Network commitments.

• Direct report to the EVP, Value-Based Networks; may lead assigned staff, project teams, consultants, or matrixed resources based on business need.

Key Responsibilities:

1. Client Partnership and Governance

• Serve as the primary senior Network relationship lead for the client and build trusted relationships with designated client leaders and stakeholders.

• Establish and lead a disciplined governance model, including operating reviews, client health reporting, issue and decision logs, action tracking, escalation pathways, and executive updates.

• Develop an integrated understanding of the client’s products, membership, markets, specialties, growth plans, contractual commitments, and service expectations; translate those priorities into an enterprise Network roadmap.

• Lead client-facing discussions with concise performance updates, risks, root causes, options, recommendations, and accountable follow-up.

• Oversee analysis and resolution of client complaints and network issues, including per-1,000 normalization, market hot-spot identification, trend analysis, remediation plans, and evidence of closure.

• Coordinate a consistent enterprise response to the client across Network Operations, specialty leaders, Contracting, Analytics/BI, Credentialing, Implementation, Finance, Legal, Compliance, and other functions.

• Anticipate relationship, access, implementation, and performance risks; escalate material concerns early with clear business impact and recommended action.

1. Multi-Specialty Network Strategy, Access, and Growth

• Maintain an integrated view of the client’s multi-specialty network needs and broader enterprise network priorities across products, lines of business, markets, and growth initiatives.

• Coordinate geographic-access and network-adequacy monitoring, gap assessments, corrective action plans, exception requests, payer submissions, and supporting documentation.

• Lead cross-functional remediation of access gaps through provider recruitment, contracting, directory or roster correction, coverage solutions, market-level escalation, or other approved interventions.

• Support priority provider contracting, amendments, rate and reimbursement analyses, network expansion, and value-based care initiatives, with emphasis on client commitments and EVP-directed enterprise priorities.

• Ensure provider-facing work is aligned with the accountable specialty or Network leader, with clear roles, handoffs, messaging, and escalation protocols.

1. Network Operations and Shared Services Leadership

• Build and lead scalable Network Operations and shared-services capabilities that establish common frameworks, tools, operating cadence, controls, and service standards across Network segments.

• Design and govern a single intake-to-execution model that makes demand, priority, ownership, capacity, dependencies, and status visible from request through resolution.

• Establish throughput, cycle-time, capacity, quality, and delivery measures; use performance data to identify constraints, rebalance resources, and improve speed to market.

• Partner with segment leaders to preserve specialty ownership while centralizing repeatable, process-driven activities where standardization improves quality, efficiency, or scale.

• Clarify roles, decision rights, handoffs, and escalation paths across contracting, credentialing and onboarding, training, provider support, analytics, and operational teams.

• Build an operating model that supports growth without proportional increases in headcount by reducing duplication, manual handoffs, rework, and offline tracking.

1. Enterprise Network Performance and Client Health

• Own the Network contribution to client health routines, including weekly reporting, open deliverables, risk assessment, executive narratives, and closure of assigned commitments.

• Create a scalable reporting approach by client and specialty, including geo-access, complaints, recruitment, contracting, implementation, provider performance, capitation, and other agreed measures.

• Partner with Analytics/BI leaders to define requirements, establish priorities, validate outputs, document methodologies, and secure sustainable reporting frequencies and service levels.

• Oversee development and use of dashboards supporting PEC capitation, routine vision performance, quarterly business reviews, geo-access, provider/network performance, and other executive priorities.

• Distinguish true Network operating issues from payer, benefit, claims-payment, or other root causes outside Network control, while ensuring the client receives a coordinated resolution plan.

1. Strategic Operations, Financial Planning, and Vendor Management

• Lead development and ongoing management of the Network operating budget, forecasts, workforce and capacity assumptions, and material variances in partnership with Finance and functional owners.

• Own the Network Financial Value Framework and related performance dashboards, including unit cost, utilization, leakage, value-based care outcomes, productivity, and other agreed economic measures; connect operational performance to enterprise planning and Board reporting in partnership with Finance, Analytics, and Actuarial.

• Oversee Network vendor strategy, business cases, renewals, consolidation opportunities, and contract transitions, including geo-access and analytics capabilities such as Quest Analytics.

• Evaluate vendor proposals based on total cost, implementation timing, functionality, operational risk, contractual terms, and the ability to retire duplicative legacy costs.

• Maintain a portfolio view of strategic Network initiatives, resource dependencies, decision points, milestones, and financial implications; recommend prioritization to the EVP.

• Develop executive and SLT materials on provider reimbursement, network economics, access, performance, strategic tradeoffs, and investment needs.

1. Network Transformation and Operating Discipline

• Sponsor and advance Network automation and workflow transformation, including provider ticketing, intake, Tracker adoption, work routing, status visibility, and closed-loop resolution.

• Define future-state processes that reduce duplicative work, manual handoffs, inconsistent tracking, and reliance on individual spreadsheets or offline follow-up.

• Partner with Technology, Transformation, Operations, and end users to document requirements, assess solutions, sequence implementation, and measure adoption and benefits.

• Lead change management for assigned Network tools and processes, addressing resistance through role clarity, workflow redesign, training, controls, and transparent performance measures.

• Create reusable playbooks, governance standards, templates, and reporting structures that improve execution across specialties and clients.

1. Policy, Reimbursement, and Cross-Functional Decision Support

• Coordinate cross-functional review of emerging provider policy and operating questions involving Network, Clinical, Legal, Compliance, Credentialing, Claims, and Finance.

• Use claims and operational data to size issues, distinguish isolated activity from material exposure, and support proportionate policy or control decisions.

• Lead or coordinate reimbursement analyses and executive briefings, including current-state economics, provider impact, client or MLR implications, and recommended actions.

• Ensure approved decisions are translated into documented policy, system, contracting, communication, and operational changes with accountable owners and effective dates.

• Complies with company policies, contractual obligations, confidentiality requirements, and applicable regulatory standards.

Qualifications:

Required

• Bachelor’s degree in business, healthcare administration, finance, public health, or a related field, or equivalent relevant experience.
• 10+ years of progressive leadership experience in provider network management, payer/client relationship management, managed care, healthcare operations, contracting, strategy, or a related field.
• 5+ years leading complex cross-functional initiatives, client relationships, enterprise programs, or teams at a Director or senior leadership level.
• Demonstrated experience with multi-specialty network strategy, network adequacy/geo-access, provider recruitment or contracting, client performance, and issue resolution.
• Working knowledge of managed-care economics and provider reimbursement, including fee schedules, Medicare-based rates, case rates, capitation/sub capitation, and value-based arrangements.
• Experience defining analytics and dashboard requirements, interpreting claims and operational data, and converting findings into executive decisions and action plans.
• Experience with budgeting, forecasting, workforce and capacity planning, vendor evaluation, business cases, and executive-level presentations.
• Demonstrated experience building or scaling shared services or centralized operating models, including intake-to-execution workflows, governance, service levels, capacity planning, and KPI dashboards.
• Proven ability to operate as a Chief of Staff, strategic advisor, PMO leader, or equivalent partner to an executive leader.
• Ability to manage competing priorities, create structure in ambiguous situations, and drive execution across teams without direct authority.
• Executive communication, facilitation, negotiation, and problem-solving skills; ability to communicate credibly with payer and provider leaders.
• Advanced proficiency with Microsoft Excel, PowerPoint, and Word; familiarity with BI, geo-access, workflow, ticketing, and project-tracking tools.
• Ability to travel as business needs require.

Preferred

• Experience in Medicare Advantage and additional managed-care lines of business, including Commercial, Medicaid, or Exchange.
• Experience supporting delegated specialty networks, multi-state expansion, credentialing, directories/rosters, contract implementation, or client reporting.
• Experience leading workflow automation, operating-model redesign, or technology-enabled Network transformation; Lean or Six Sigma experience is a plus.
• Master’s degree in business, healthcare administration, public health, finance, or a related field.

Measures of Success

• Client stakeholder confidence, effective governance, and timely closure of commitments and escalated issues.
• Measurable progress against the client’s multi-specialty network, market readiness, access, growth, and performance priorities.
• Timely, accurate, and sustainable client and executive reporting, with clearly defined metrics, methodologies, owners, and reporting cadence.
• Improved turnaround time and reduced recurrence for network complaints, access gaps, implementation defects, and operational issues.
• On-time delivery of EVP-directed enterprise initiatives, with transparent risks, decisions, dependencies, resource constraints, and business outcomes.
• Measurable improvement in intake visibility, cycle time, throughput, capacity utilization, service levels, and reduction of manual handoffs or duplicate work.
• Clear linkage between Network operating performance and financial value, including unit cost, utilization, leakage, value-based outcomes, productivity, and investment requirements.
• Budget performance and documented savings or value from vendor optimization, contract consolidation, and resource prioritization.
• Adoption of standardized tracking, ticketing, workflow, and governance practices across assigned Network teams.
• High-quality executive decision support for reimbursement, provider policy, network economics, and strategic investments.