- Pay
- $160–180k
- Where
- Remote, USA · Remote
- Level
- Senior
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…