Director, Provider Network Operations

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🕒 July 23

🏰 Missouri – Remote

🏰 Missouri – 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

• Oversee Provider Network divisions including Provider Relations, Provider Data Management, Credentialing, and provider platform interoperability • 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 • Develop, direct, and execute Credentialing division objectives • Develop and execute 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, and internal stakeholders to optimize interoperability and streamline network operations • Identify interoperability gaps and develop system compatibility solutions • Ensure integrated systems support state, federal, and NCQA standards and organizational policies • Develop automated workflows for accurate data synchronization across platforms and departments • Improve functionality through LEAN methodologies and resources • Participate in strategic planning, execution, resource allocation, and performance monitoring • Work with executive leadership on processes, technology, and staffing resources to achieve performance and efficiency targets • Oversee provider collaborative efforts with other departments and leaders • Guide functional leaders in developing business plans • Design and deliver provider education programs • Assess provider feedback and implement relationship improvements • 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 as new competencies are needed • Hire, develop, coach, and review staff; provide feedback and performance evaluations • 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 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

🏖️ Benefits

• Equal opportunity employment • Travel approximately 15% of the time • Coaching and training programs • Employee engagement and cultural enhancement programs • Participation in strategic planning, committees, and professional development activities