Director, Provider Network Operations

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🔥 0 minutes ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $108.5k - $184.4k / year

⏰ Full Time

🔴 Lead

🌐 Network Operations

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PACIFICSOURCE

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1933

Not-for-profit health plans

📋 Description

• Accountable for Provider Network department core operational, data, and systems functions • Oversee Provider Relations, Provider Data Management, Credentialing, and provider platform interoperability divisions • Lead department-specific and cross-departmental planning and execution efforts • 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 Provider Reimbursement Insights and Analytics Team to meet objectives • Direct Credentialing division efforts to ensure compliance and operational excellence • Develop provider education and relationship management strategies • 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 • Ensure systems support state, federal, NCQA, and organizational compliance requirements • Develop automated workflows for accurate data synchronization • Improve functionality through LEAN methodologies and resources • Participate in strategic planning, execution, resource allocation, and performance monitoring • Work with executive leadership on processes, technology, people resources, performance metrics, and efficiency targets • Oversee provider collaborative efforts and guide functional leaders in business planning • Design and deliver provider education programs and address 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 • Oversee resource prioritization and development of new competencies • Hire, develop, coach, and conduct performance reviews for staff • Enhance employee engagement within Provider Network • Oversee division budgets, monitor spending, and implement corrective actions • Participate in Manager/Supervisor meetings, PRISM walks, internal committees, and department activities • Assess innovative provider payment methodologies for approval and implementation • Perform other duties as assigned

🎯 Requirements

• Minimum of 8 years of experience in a leadership role overseeing healthcare provider network operations or related functions • Experience leading at least two of Provider Relations, Credentialing, and Provider Data Management strongly preferred • Experience managing large, multi-level teams and complex operational portfolios • Knowledge of provider reimbursement methodologies, provider network operations, compliance requirements, and healthcare data management • 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 • Ability to read and comprehend both written and spoken English • Communicate clearly and effectively • Meet department and company performance and attendance expectations • Follow PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information • Stoop and bend • Sit and/or stand for extended periods of time • Perform repetitive motions including typing, sorting and filing • Light lifting and carrying of files and business materials

🏖️ Benefits

• Equal opportunity employment • Leadership, coaching, and professional development opportunities • Employee engagement and cultural enhancement programs • General office setting with ergonomically configured equipment • Travel required approximately 15% of the time