Director, Provider Network Operations

Job not on LinkedIn

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $108.5k - $184.4k / year

⏰ Full Time

🔴 Lead

🌐 Network Operations

👻 Ghost score 13%

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 • Guide strategic initiatives for network setup and maintenance, provider data integrity, provider education and service, contract implementation, provider-related claims, audits, corrective action plans, and directory accuracy • Collaborate with reimbursement insights and analytics teams to meet objectives • Direct Credentialing division efforts for compliance and operational excellence • Develop strategies for provider education, relationship management, 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 streamline operations • Ensure systems support state, federal, and NCQA standards and organizational policies • Develop automated workflows and improve functionality using LEAN methodologies • 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 developing business plans • Design and deliver provider education programs and address provider feedback • Collaborate 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; oversee resource prioritization and competency development • Hire, develop, coach, and evaluate staff and enhance employee engagement • Oversee division budgets and spending and take corrective action as needed • Assess innovative provider payment methodologies for approval and implementation • Participate in manager/supervisor meetings, PRISM walks, internal committees, and department activities • Follow privacy policy and HIPAA requirements; perform other assigned duties

🎯 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 • 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 • 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 • 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 • Ability to stoop and bend, sit and/or stand for extended periods, perform repetitive motions, and lightly lift and carry files and business materials

🏖️ Benefits

• Equal opportunity employment • Travel approximately 15% of the time • General office setting with ergonomically configured equipment • At-will employment