Chief Provider Network Operations & Strategy

PacificSource Health Plans

Clayton (NC)

Remote

USD 180,000 - 260,000

Full time

8 days ago

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Job summary

PacificSource Health Plans seeks a senior leader to oversee Provider Network operations, including Provider Relations, Credentialing and Data Management. You will align network strategy with enterprise goals and advance education, interoperability, and compliance across Medicaid, Medicare and Commercial lines.

The role requires strategic leadership, strong collaboration with executive teams, and coaching of multi-level teams.

Qualifications

Minimum 8 years of leadership experience in healthcare provider networks.
Experience with Provider Relations, Credentialing, and Provider Data Management.
Bachelor's degree in business, healthcare administration, or related field.
Ability to travel approximately 15% of the time.

Responsibilities

Oversight of Provider Network departments including Relations, Credentialing and Data Management.
Lead cross-department planning and execution to meet KPIs across Medicaid, Medicare and Commercial.
Develop strategies for provider education and relationship management.
Ensure network platform interoperability with legacy and new systems.
Ensure compliance with state, federal, NCQA standards and internal policies.
Collaborate with executives to allocate resources and monitor performance.
Recruit, coach and evaluate staff; drive engagement and culture within Provider Network.