Director, Provider Network Operations

🕒 July 24

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $108.5k - $184.4k / year

⏰ Full Time

🔴 Lead

🌐 Network Operations

👻 Ghost score 23%

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 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 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 • Develop, direct, and execute Credentialing division objectives while ensuring compliance and operational excellence • Develop and execute provider education and relationship-management strategies • Lead integration and operational effectiveness of provider network platforms with legacy and emerging systems • Foster partnerships with software vendors and internal stakeholders to optimize interoperability and streamline operations • Collaborate with IT and operational leaders to identify interoperability gaps and develop solutions • Ensure integrated systems comply with state, federal, NCQA, and organizational standards • Develop automated workflows to synchronize data 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 and guide division leaders in business planning • Design and deliver provider education programs and implement improvements based on 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 hiring, staff development, coaching, performance reviews, employee engagement, budgets, and spending • Participate in manager/supervisor meetings, PRISM walks, internal committees, and department activities • Assess innovative provider payment methodologies • Follow privacy and HIPAA requirements and perform other assigned duties

🎯 Requirements

• Minimum 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 • Advanced knowledge of provider reimbursement and reimbursement methodologies, provider relations, or provider partnership activities • Ability to lead people in a matrixed organization and build high-performing teams • Proven collaborative interaction experience with provider leaders • Ability to develop and execute strategy • Ability to read and comprehend written and spoken English • Must communicate clearly and effectively • Travel required approximately 15% of the time • Ability to perform physical requirements including stooping, bending, extended sitting/standing, repetitive typing/sorting/filing, and light lifting/carrying • Knowledge of HIPAA laws, regulations, confidentiality, and protected health information security

🏖️ 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, learning, development, and career advancement • Work-life balance support