Director, Provider Network Operations

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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

• Accountable for Provider Network department core operational, data, and systems functions • Oversee Provider Relations, Provider Data Management, Credentialing, and provider platform interoperability divisions • Lead department-specific and cross-departmental planning and execution efforts • Guide strategic initiatives for network setup and maintenance, provider data integrity, education, service, contract implementation, claims, audits, corrective action plans, and directory accuracy • Collaborate with Provider Reimbursement Insights and Analytics to meet objectives • Direct Credentialing division efforts for 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 and internal stakeholders to optimize interoperability and streamline operations • Collaborate with IT and operational leaders to address interoperability gaps • Ensure systems support state, federal, NCQA, and organizational requirements • 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 on processes, technology, and staffing resources • Oversee provider collaborations with other departments and leaders • Guide functional leaders in developing business plans • Design and deliver provider education programs • Assess provider feedback and implement relationship improvements • Collaborate with Operations, IT, Health Services, Analytics, Finance, and other departments • Oversee annual IT work plans, initiative plans, budgets, and resource needs • Implement coaching and training programs with division leaders • Oversee resource prioritization as new competencies are needed • Hire, develop, coach, and conduct performance reviews for staff • Provide regular feedback and one-on-one meetings to 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 • Follow privacy policy and HIPAA confidentiality and security requirements • 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 the following areas strongly preferred: Provider Relations, Credentialing, and Provider Data Management • 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 • Ability to read and comprehend both written and spoken English • Communicate clearly and effectively • Travel required approximately 15% of the time • Ability to stoop and bend • Ability to sit and/or stand for extended periods while performing core job functions • Repetitive motions including typing, sorting, and filing • Light lifting and carrying of files and business materials

🏖️ 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 • Individual development and career advancement opportunities