Director, Provider Network Operations

🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $108.5k - $184.4k / year

⏰ Full Time

🔴 Lead

🌐 Network Operations

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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 enterprise and Provider Network performance indicators • Guide strategic initiatives covering network setup and maintenance, provider data integrity, provider education and service, contract implementation, provider-related claims, provider setup and audits, corrective action plans, and directory accuracy • Collaborate with Provider Reimbursement Insights and Analytics to meet objectives • Direct Credentialing division efforts to achieve objectives, 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 and streamline operations • Ensure integrated systems comply with state, federal, NCQA, and organizational standards • 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, people resources, performance metrics, 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 on network policies, reimbursement processes, and regulatory requirements • Assess provider feedback and implement relationship improvements • 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 with division leaders • Oversee resource prioritization and development of new competencies • Hire, develop, coach, and review staff • Conduct one-on-one meetings and performance evaluations for direct reports • Enhance employee engagement through education, programs, and cultural initiatives • 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 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 • Work inside in a general office setting with ergonomically configured equipment • Travel required approximately 15% of the time • 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 • Ability to read and comprehend both written and spoken English • Communicate clearly and effectively • Stoop and bend; sit and/or stand for extended periods; perform repetitive typing, sorting, and filing; light lifting and carrying

🏖️ Benefits

• Flexible telecommute policy • Medical, vision, and dental insurance • Incentive program • Paid time off and holidays • 401(k) plan • Volunteer opportunities • Tuition reimbursement and training • Life insurance • Flexible spending account • Opportunities for personal growth and advancement • Learning, development, and career advancement opportunities • Work-life balance • Training and individual development opportunities