Vice President, Center of Excellence

Job description

THE OPPORTUNITY
As the Vice President, Center of Excellence for PRI's Independent Dispute Resolution Entity division, you will be a pivotal leader within a 150+ person, rapidly growing business unit operating in a critical and exciting market bringing quality and integrity to healthcare.
You will be responsible for leading teams focused on highly strategic functions including all engagement with external stakeholders (Healthcare Providers, Commercial Health Plans, and Government Regulators), building best-in-class Quality Assurance teams to drive excellence and compliance as a No Surprises Act IDRE, establishing the processes to turn data into better education and development for our arbitrators, and setting an external communications strategy to keep PRI at the top of thought leadership and client awareness.
As VP of the CoE, you will be deeply engaged with the IDRE General Manager as well as PRI's CEO and Executive Leadership team. Your success will directly impact the company's success.
This role demands keen strategic vision, exceptional change management and team empowerment, top notch emotional intelligence and ability to manage critical client relationships, a deep commitment to excellence, and the ability to drive continuous improvement through rigorous analysis.
You and your team will manage our most important external relationships and you will quickly become a thought leader in the No Surprises ACT IDR landscape. At the same time, you will build, mentor, and empower a team of quality professionals, ensuring consistent application of policy and strong decision-making, and driving a measurable impact on operational efficiency and client satisfaction. Your teams will lead the charge in upholding the integrity and accuracy of our review processes, ensuring superior outcomes and maintaining our strong reputation in the healthcare landscape.
We are scaling fast and changing every day, so you should thrive at leading in high-pace, rapidly evolving environments and be motivated by leading teams through transformation.
This is the perfect role for someone with strong executive presence who is passionate about driving quality and integrity in healthcare, loves building executive relationships, and excels at leadership in a high-growth environment. You should bring expertise in health insurance, claims, appeals, utilization management, revenue cycle or a similar health-related compliance driven space, and you ideally have had substantial interactions with Providers, Payers, and Regulators.
PRI has a strong reputation in healthcare and is growing rapidly across multiple business lines. Success in this role will lead to greater responsibility, including management of key operating areas and the potential opportunity to lead the business unit.
REPORTING RELATIONSHIP
Reports directly to the Executive Director of the Independent Dispute Resolution Division and will have constant interaction with the Executive Leadership Team. Serves as one of two VPs in the division.
KEY RESPONSIBILITIES
Strategic External Engagement: Lead and cultivate all strategic engagement with critical external stakeholders, including Providers, Commercial Health Plans, and Government Regulators, ensuring robust relationships and alignment with PRI's mission.
Quality Assurance Vision and Execution: Develop, implement, and continuously refine a best-in-class, comprehensive, quality assurance framework and methodology, ensuring excellence, compliance, and sound decision-making across all highly-regulated IDRE operations.
Thought Leadership and Communication Strategy: Design and execute an impactful external communications strategy to position PRI as a leading voice and authority in healthcare claims review, enhancing client awareness and reinforcing our reputation for integrity.
Data-Driven Insights and Education: Establish and optimize processes to transform complex operational data into actionable insights, driving continuous improvement in employee education, development, and overall operational performance.
Team Empowerment and Development: Build, mentor, and empower high-performing teams of quality professionals, fostering a culture of accountability, analytical rigor, and unwavering commitment to excellence and continuous learning.
Process Excellence and Innovation: Champion initiatives to optimize review processes, integrating advanced technologies and automation solutions to significantly enhance efficiency, accuracy, and scalability within the quality assurance function.
Compliance and Integrity Oversight: Ensure all quality assurance activities and review processes strictly adhere to relevant regulatory requirements, legal standards, and internal policies, proactively safeguarding the integrity and accuracy of every claims review outcome.
EDUCATION / CERTIFICATIONS
Bachelor's degree required, preferably in Healthcare Administration, Business, Finance, or a related analytical field. Master's degree highly preferred.
EXPERIENCE AND SKILLS
A proven track record of at least five (5) years of progressive, senior-level experience leading strategic functions around stakeholder engagement, account management, customer success, or quality within healthcare or a similarly highly regulated industry. Demonstrated success in building, leading teams focused on quality, compliance, or excellence. Experience in high-growth, rapidly transforming environments is critical, with a history of driving continuous improvement through rigorous analysis.
Significant direct experience and established relationships with Providers, Payers, and Regulators is highly desirable.
Skills: Exceptional strategic vision, coupled with outstanding change management and team empowerment capabilities. Possesses top-notch emotional intelligence and a proven ability to manage complex, critical client relationships. Superior analytical and problem-solving skills with a strong record of identifying root causes and implementing effective, data-driven solutions. Excellent executive presence, verbal, and written communication skills to articulate complex strategies, influence stakeholders at all levels, and lead thought leadership initiatives. Proficiency in quality management tools, advanced data analysis platforms, and an understanding of automation technologies is expected.
Competencies: Possesses a results-oriented mindset with an unwavering commitment to excellence and integrity in healthcare. Demonstrates keen strategic vision, strong leadership in high-pace, rapidly evolving environments, and the ability to lead teams through transformation. A passion for building executive relationships and leading customer success.
Other Requirements: Ability to obtain and maintain U.S. Government Security Clearance.
COMPENSATION
A competitive cash package including base salary and bonus.

About PROVIDER RESOURCES INC

Join Provider Resources (PRI) and Make an Impact in Healthcare!
At PRI, we're passionate about driving integrity and advancing quality across the healthcare system. As a trusted leader in the industry, we're tackling some of healthcare's biggest challenges-improving compliance, advancing health equity, and enhancing quality and clinical outcomes while helping organizations improve care delivery and create meaningful change.
We believe that people are at the heart of healthcare, and focus on scalable, person-centered strategies that prioritize clinical excellence and evidence-based practices. Our work supports a broad network of stakeholders, including providers, patients, caregivers, payers, and regulators. We strive to enhance experiences, improve outcomes, and foster a healthier future for all.
If you're looking to be part of a forward-thinking team that makes a difference, PRI is the place for you!