Director, Provider Network Operations

Job not on LinkedIn

🕒 October 20

🐊 Florida – Remote

🐊 Florida – Remote

💵 $108.5k - $184.4k / year

⏰ Full Time

🔴 Lead

🌐 Network Operations

👻 Ghost score 20%

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PacificSource Health Plans

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1933

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

PacificSource Health Plans is a healthcare provider that offers a range of health insurance solutions, including plans for individuals, families, and employers. Their offerings include Medicare and Medicaid plans, dental coverage, and administrative services for small and large groups. Committed to member care, PacificSource emphasizes customer service and provides various resources for health management, including mental health support and wellness programs.

📋 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

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