Chief Provider Network Operations & Strategy

PacificSource; Virginia Beach (VA); Remote; USD 150,000 - 230,000; Full time

Job summary

PacificSource is seeking a senior leader to oversee the Provider Network operations, including relations, data management, credentialing, and interoperability across Medicaid, Medicare, and Commercial lines. This role partners with executive teams to align strategies with company goals and values.

Responsibilities include strategy development, staff leadership, and cross-department collaboration to maintain enterprise KPIs, implement provider education programs, and ensure HIPAA/compliance

Qualifications

• Minimum 8 years in a leadership role overseeing healthcare provider network operations or related functions.
• Experience in Provider Relations, Credentialing, and Provider Data Management.
• Knowledge of provider reimbursement methodologies and healthcare data management.
• Ability to lead in a matrixed organization and build high-performing teams.

Responsibilities

• Oversee Provider Network divisions including Provider Relations, Provider Data Management, Credentialing, and provider platform interoperability.
• Lead cross-department planning and execution to maintain enterprise and network KPIs across Medicaid, Medicare, and Commercial lines.
• Develop and implement strategies for provider education and relationship management.
• Ensure compliance with state, federal, and NCQA standards; optimize data synchronization across platforms.
• Partner with IT, Analytics, and Operations to align initiatives and budgets.
• Hire, coach, and assess staff; drive engagement and performance reviews.

Skills

Leadership

Provider network operations

Provider relations

Credentialing

Data management

Compliance (HIPAA)

Strategic planning

Budgeting

Team leadership

Communication

Education

Bachelor's degree in business/healthcare administration

Job description

PacificSource is seeking a senior leader to oversee the Provider Network operations, including relations, data management, credentialing, and interoperability across Medicaid, Medicare, and Commercial lines. This role partners with executive teams to align strategies with company goals and values.

Responsibilities include strategy development, staff leadership, and cross-department collaboration to maintain enterprise KPIs, implement provider education programs, and ensure HIPAA/compliance