Director, Provider Network Operations

Job not on LinkedIn

🔥 19 hours ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $108.5k - $184.4k / year

⏰ Full Time

🔴 Lead

🌐 Network Operations

👻 Ghost score 20%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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PACIFICSOURCE

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1933

Not-for-profit health plans

📋 Description

• Oversee Provider Network divisions including Provider Relations, Provider Data Management, Credentialing, and provider platform interoperability • Lead department-specific and cross-departmental planning and execution to maintain Provider Network and enterprise KPIs • Guide strategic initiatives for network setup and maintenance, provider data integrity, provider education and service, contract implementation, provider-related claims, provider setup and audits, corrective action plans, and provider directory accuracy • Collaborate with reimbursement insights and analytics teams to meet objectives • Develop and execute Credentialing division objectives while ensuring compliance and operational excellence • Develop provider education and relationship management strategies to improve provider collaboration, engagement, and satisfaction • Lead integration and operational effectiveness of provider network platforms with legacy and emerging systems • Partner with software vendors, IT teams, operational leaders, and internal stakeholders to improve interoperability and system compatibility • Ensure integrated systems comply with state, federal, and NCQA standards and organizational policies • Develop automated workflows for accurate cross-platform and cross-department data synchronization • Improve functionality through LEAN methodologies and resources • Participate in strategic planning, execution, resource allocation, and performance monitoring • Work with executive leadership to align processes, technology, and staffing with performance and stewardship targets • Oversee provider collaborative efforts and division business plans • Design and deliver provider education programs and assess provider feedback • Coordinate initiatives with Operations, IT, Health Services, Analytics, Finance, and other departments • Oversee annual IT work plans, initiative work plans, financial budgets, and resource needs • Develop coaching and training programs with division leaders • Hire, develop, coach, and conduct performance reviews for staff and direct reports • Enhance employee engagement within Provider Network • Oversee division budgets and spending and take corrective action as needed • Participate in manager/supervisor meetings, PRISM walks, internal committees, and key department activities • Assess new provider payment methodologies for approval and implementation • Meet department and company performance and attendance expectations • Perform other duties as assigned

🎯 Requirements

• Minimum of 8 years of experience in a leadership role overseeing healthcare provider network operations or related functions required • Experience leading at least two of Provider Relations, Credentialing, and Provider Data Management strongly preferred • Demonstrated experience managing large, multi-level teams and complex operational portfolios • Knowledge of provider reimbursement methodologies, provider network operations, compliance requirements, and healthcare data management required • Experience developing and executing strategy within a matrixed organization preferred • Bachelor’s degree in business, health care administration, finance, or related field required • Candidates with an associate’s degree and 2 years of relevant experience, or a high school diploma and 4 years of relevant experience, in addition to the required minimum years of work experience will also be considered • Ability to develop and execute strategy • Advanced knowledge of provider reimbursement and reimbursement methodologies, provider relations, or provider partnership activities in relevant markets and geography • Ability to lead people in a matrixed organization structure and build high performing teams • Proven collaborative interaction experience with provider leaders • Accountable leadership, business and financial acumen, empowerment, influential communications, situational leadership, strategic planning • Ability to read and comprehend both written and spoken English • Communicate clearly and effectively • Ability to stoop and bend, sit and/or stand for extended periods, perform repetitive motions, and light lifting and carrying • Must follow privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information

🏖️ Benefits

• Travel required approximately 15% of the time • Equal opportunity employment • Employee engagement, education, and cultural enhancement programs • Coaching and training programs • General office setting with ergonomically configured equipment