Director, Qualification Engagement

About Lantern

Lantern is the specialty care platform connecting people with the best care when they need it most. By curating a Network of Excellence comprised of the nation's top specialists for surgery, cancer care, infusions and more, Lantern delivers excellent care with significant cost savings to employers and their workforces. Lantern also pairs members with a dedicated care team, including Care Advocates and nurses, for the entirety of their care journey, helping them get back to good health, back to their families and back to work. With convenient access to specialists nationwide, Lantern means quality care is within driving distance for most. Lantern is trusted by the nation's largest employers to deliver care to more than 6 million members across the country. Learn more about us at lanterncare.com. 

Director, Qualification Engagement

Lantern is looking for a Director, Qualification Engagement to join our Clinical team as the external voice of specialist qualification. Lantern operates a specialty care network built on a simple promise to clients and members: every specialist in our Network of Excellence has been evaluated, by procedure, against evidence-based clinical standards. The Clinical team sets those standards, runs the Qualification Committee, and is investing in the tooling and process that make qualification faster and more consistent for practices.

As that investment matures, the part of the process that will always require a human is the conversation with practices: explaining what we evaluate and why before a group applies, delivering approvals and procedure-level decisions clearly and respectfully, and giving groups that receive an adverse finding a credible explanation and a fair path to respond.

In this role you will own how qualification is explained, how decisions are delivered, and how practices experience the process. You will also bring the Clinical perspective into provider conversations and select client meetings and collaborate with the Provider Network team to educate and set our partner practices up for success. This is a Director-level individual contributor role, accountable for the entire qualification engagement function, with the potential to lead qualification operations staff as the function scales. This role suits two kinds of candidate: a seasoned credentialing, medical staff, or provider network leader, or a physician or surgeon ready to move from direct patient care into a high-impact role shaping network quality. What the role requires is credibility with surgeons and the judgment to deliver difficult clinical decisions well.

Location: Remote

Responsibilities:

 Qualification decision communications

• Deliver every qualification, requalification, and standing-change decision to practices and specialists, including full approvals, procedure-level approvals, holds pending information, denials, and removals from the network.
• Translate Qualification Committee reasoning into clear, accurate, clinically literate written and verbal communication that a practice administrator and a surgeon can both act on.
• Own the adverse-finding workflow: request documentation or clarification from practices, track responses, bring complete information back to the Committee, and close the loop within defined service levels.
• Handle pushback with composure and consistency, explaining the rationale and the published guideline review process, and escalate to the Associate CMO only when a case warrants clinical judgment beyond the guidelines.
• Maintain the correspondence record so that any decision and its communication history can be reconstructed and audited.

Practice and specialist education.

• Build and maintain the practice-facing explanation of qualification at Lantern: the seven quality domains we evaluate, the data sources we use, what the thresholds mean, and what a practice should expect at each stage.
• Lead qualification overview conversations with prospective and newly contracted practices so that groups understand requirements before they invest effort and unqualified candidates are identified before contracting rather than after.
• Set the qualification standard for Provider Success Managers, d so that they can answer first-line questions accurately and own the practice relationship without routing routine questions to Clinical.
• Communicate guideline changes to affected practices and specialists, including re-evaluation pathways when standards evolve.

Qualification process operations

• Own the workflow from Committee decision to delivered communication, including letter generation from Prism, tracking, and turnaround reporting against the five-business day target from submission to decision.
• Coordinate the Qualification Committee agenda and decision record in partnership with the Clinical Quality Manager and ensure the handoff to Network for placeability is clean and timely.
• Capture and triage practice feedback.
• Define and report the metrics that show whether the process is working.

Clinical representation on provider and client conversations

• Serve as the Clinical representative on provider calls that require clinical context, including qualification questions, clinical escalation feedback to practices, and specialist-facing quality discussions, with defined criteria for when a physician leader should join.
• Represent the Clinical team on select commercial pitches and client conversations.

Function leadership

• Set the strategy, operating model, and service levels for qualification engagement, build the staffing case as volume grows, and represent the function in leadership forums alongside the Clinical team
• Expected mix once ramped: roughly 70 to 80 percent qualification and practice-facing work, 20 to 30 percent provider and client representation. Commercial representation begins after the first 90 days.

Requirements:

• Bachelor's degree or equivalent professional experience.
• Credibility with surgeons. You command the respect of surgeons and practice leaders and can deliver difficult, clinically grounded decisions in a way that lands and keeps the relationship intact. We expect this to come from one of two backgrounds:
• A clinical career: you are a physician or surgeon (MD or DO), or another licensed clinician, looking to apply your clinical judgment beyond direct patient care.
• A credentialing or network career: ten or more years in medical staff services or credentialing leadership, payer provider network or provider relations management, or surgical practice or ASC administration, including clinical operations in orthopedics, spine, bariatrics, or multi-specialty surgery.
• Exceptional communication. You write clearly and precisely, you explain complex criteria without jargon or condescension, and you can hold a hard conversation with a surgeon or practice executive and leave the relationship intact.
• High emotional intelligence and judgment. You understand what a qualification decision means to a surgeon's identity, income, and reputation. You can be empathetic and firm at the same time, and you know when to listen, when to explain, and when to escalate.
• Clinical literacy. Working knowledge of surgical specialties and procedures, how surgical practices operate, how surgeons are trained and credentialed, and how practice administrators, schedulers, and billing teams interact with payers and networks.
• Independent problem solving and project management. You run multi-step processes with many stakeholders, track details without being asked, and improve the process rather than only operating it.
• Comfort with data and tools. You can read a data-driven profile, understand what a volume threshold or an outcome metric means, spot an error before it reaches a practice, and work fluently in Microsoft 365 and modern software tools, including AI-assisted drafting with appropriate review.
• Integrity under pressure. You hold the standard when a practice, a colleague, or a commercial deadline pushes for an exception, and you route that pressure into the proper review process.
• Leadership and influence. You have set strategy for a function or program, influenced senior leaders and physicians without formal authority, and are ready to build and lead a team, or to grow into that as the function scales.

Strong Candidates will:

• Hold a credentialing or medical staff certification (for example CPCS or CPMSM through NAMSS), or have direct experience communicating adverse credentialing or peer review determinations to physicians.
• Have built enablement or training materials for field or account teams.
• From a clinical background: experience beyond direct patient care, such as medical directorship, utilization or peer review, committee or quality work, or clinical research.
• From a credentialing background: a credentialing or medical staff certification (for example CPCS or CPMSM through NAMSS), or direct experience communicating adverse credentialing or peer review determinations to physicians
• Have presented to employer benefits leaders, consultants, or health plan audiences.
• Be energized by building a function from the ground up with new tooling, and act with urgency and precision when a practice or a member is waiting on an answer.

Benefits

• Medical Insurance
• Dental Insurance
• Vision Insurance
• Short & Long Term Disability
• Life Insurance
• 401k with company match
• Paid Time Off
• Paid Parental Leave

Compensation: Base salary range: $160,000 to $180,000 plus bonus potential depending on relevant experience, location, and qualifications.

About You:

• You use LOGIC in your decision making and understand that progress is critical to making change. You focus on the execution of your content while balancing a fast-paced environment and you take the time to celebrate both the small & big wins. 
• INCLUSION is a core tenant of your personal beliefs. A diverse and inclusive environment is incredibly important to you. You understand and desire to be a part of a diverse team with different experiences and perspectives & you cherish the differences in each individual that you interact with.
• You have the GRIT, drive and ambition to tackle big problems. Big problems require big ideas and a team that supports new ideas. 
• You care deeply for your customers are driven to keep HUMANITY in all decisions. Your customers aren’t just the individuals using your product. They are the driving factor in your motivation to make a change.
• Integrity guides you in life. Focusing on the TRUTH vs. giving people the answers they want to hear. 
• You thrive in a Team Environment. Collaboration is key in innovation and creating change.

These pillars of LIGHT are a reminder to our team that we are making a difference by providing guidance and support in navigating the often complex and confusing landscape of healthcare. We hope that through this LIGHT, individuals can find their way to the best care, resources, and support they need to get back to life. 

If this sounds like you, we would love to connect to speak further about career opportunities at Lantern.

Please apply to our role & someone from our Talent Acquisition Team will reach out to help you navigate our interview process.

Lantern does not discriminate on the basis of race, sex, color, religion, age, national origin, marital status, disability, veteran status, genetic information, sexual orientation, gender identity or any other reason prohibited by law in provision of employment opportunities and benefits.