Director, Provider Network Operations

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🔥 0 minutes ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $108.5k - $184.4k / year

⏰ Full Time

🔴 Lead

🌐 Network Operations

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PacificSource Health Plans

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1933

⚕️ Healthcare Insurance

💸 Finance

🧘 Wellness

Healthcare Insurance • Finance • Wellness

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

• Guide strategic initiatives for the Provider Network Operations division. • Collaborate with Provider Reimbursement Insights and Analytics Team. • Develop, direct and execute efforts to meet Credentialing division objectives. • Lead initiatives to enhance provider collaboration, engagement, and satisfaction. • Collaborate with IT teams to identify interoperability gaps. • Ensure integrated systems support compliance with state, federal, and NCQA standards. • Develop automated workflows and processes for data synchronization. • Strengthen relationship management frameworks for consistent communication. • Actively participate in department strategic planning and execution. • Oversee provider collaborative efforts in coordination with key departments. • Guide division functional leaders in developing successful business plans. • Design and deliver provider education programs. • Regularly assess provider feedback for relationship improvements.

🎯 Requirements

• Minimum of 8 years in healthcare operations required. • Management experience required. • Must have expertise in provider reimbursement methodologies, provider relations, data management and compliance. • Experience developing, communicating, and executing strategy in a matrixed organizational structure. • 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 will also be considered.

🏖️ 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 • options such as a flexible spending account