Director, Provider Network Operations

Job not on LinkedIn

🔥 0 minutes ago

⚔️ Virginia – Remote

⚔️ Virginia – 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

⚕️ 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 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 provider directory accuracy • Collaborate with Provider Reimbursement Insights and Analytics to meet objectives • Develop, direct, and execute Credentialing division objectives for compliance and operational excellence • Develop and execute provider education and relationship-management strategies • Lead integration and ongoing 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 system compatibility • Ensure integrated systems support state, federal, and NCQA standards and organizational policies • Develop automated workflows and improve functionality using LEAN methodologies • Participate in strategic planning, execution, resource allocation, and performance monitoring • Work with executive leadership to align processes, technology, and people resources with performance and efficiency targets • Oversee provider collaborative efforts and division business plans • Design and deliver provider education programs and address provider feedback • 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 • Hire, develop, coach, and conduct performance reviews for staff and direct reports • Enhance employee engagement within Provider Network • Oversee division budgets and spending and implement corrective actions 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 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 • 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 • Accountable leadership, business and financial acumen, empowerment, influential communications, situational leadership, and strategic planning • Ability to read and comprehend both written and spoken English • Ability to 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 • Must meet department and company performance and attendance expectations • Must follow PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information

🏖️ Benefits

• Full-time employment • Work-from-home arrangement • Equal opportunity employment • Employee engagement, education, and cultural enhancement programs • Coaching and training programs • Approximately 15% travel