Director, Provider Network Operations

Job not on LinkedIn

🔥 18 hours ago

🇺🇸 United States – Remote

💵 $108.5k - $184.4k / year

⏰ Full Time

🔴 Lead

🌐 Network Operations

👻 Ghost score 0%

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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 • Guide strategic initiatives for network setup and maintenance, provider data integrity, provider education and service, contract implementation, provider-related claims, provider audits, corrective action plans, and directory accuracy • Collaborate with reimbursement insights and analytics teams to meet objectives • Develop and execute Credentialing, 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, and internal stakeholders to improve interoperability and system compatibility • Ensure integrated systems comply with state, federal, NCQA, and organizational standards • Develop automated workflows for accurate cross-platform 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 efficiency targets • Oversee provider collaborative efforts and guide division leaders in business planning • Design and deliver provider education programs • Assess provider feedback and implement relationship improvements • Oversee annual IT and initiative work plans, financial budgets, and resource needs • Develop coaching and training programs and oversee resource prioritization • Hire, develop, coach, and conduct performance reviews for direct reports • Enhance employee engagement within Provider Network • Oversee division budgets and spending and implement corrective actions • Participate in manager/supervisor meetings, PRISM walks, internal committees, and department activities • Assess innovative provider payment methodologies • Follow privacy policy and HIPAA requirements and perform other duties as assigned

🎯 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 • 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 lift and carry files and business materials

🏖️ Benefits

• Equal opportunity employment • Travel required approximately 15% of the time • Coaching and training programs • Employee engagement education/programs and cultural enhancements • At-will employment