Chief Provider Network Operations

PacificSource Health Plans; Florida; Remote; USD 150,000 - 200,000; Full time

Job summary

PacificSource Health Plans is seeking a senior leader to manage the Provider Network Operations, guiding Provider Relations, Credentialing, and Data Management to achieve enterprise KPIs. You will drive cross‑department initiatives and ensure high‑quality provider partnerships.

You will develop strategies, coordinate education programs, and oversee system interoperability and compliance with HIPAA, NCQA, and state/federal rules, while leading a multi‑disciplinary team.

Qualifications

• Minimum of 8 years of experience in a leadership role overseeing healthcare provider network operations or related functions.
• Knowledge of provider reimbursement methodologies, provider network operations, compliance requirements, and healthcare data management.
• Bachelor’s degree in business, health care administration, finance, or related field; alternatives with relevant experience considered.

Responsibilities

• Oversee Provider Network divisions including Provider Relations, Credentialing, and Provider Data Management.
• Lead strategic initiatives for the Provider Network Operations division and align with enterprise goals.
• Collaborate with analytics to meet objectives and ensure data accuracy and reporting.
• Develop provider education and relationship management to improve collaboration and satisfaction.
• Ensure interoperability of provider network platforms with legacy and emerging systems.
• Ensure compliance with state, federal, and NCQA standards and organizational policies.
• Plan annual IT work plans, budgets, and resource needs for supervisory departments.
• Hire, coach, and evaluate staff; drive employee engagement within Provider Network.

Skills

Leadership

Strategic planning

Stakeholder collaboration

People management

Healthcare knowledge

Education

Bachelor's degree in business/healthcare administration/finance

Associate degree + 2 years relevant experience

Job description

PacificSource Health Plans is seeking a senior leader to manage the Provider Network Operations, guiding Provider Relations, Credentialing, and Data Management to achieve enterprise KPIs. You will drive cross‑department initiatives and ensure high‑quality provider partnerships.

You will develop strategies, coordinate education programs, and oversee system interoperability and compliance with HIPAA, NCQA, and state/federal rules, while leading a multi‑disciplinary team.