Director of Provider Network Operations

PacificSource; North Carolina; Remote; USD 140,000 - 190,000; Full time

Job summary

PacificSource seeks a seasoned senior leader to head Provider Network Operations in North Carolina. You will oversee Provider Relations, Credentialing, and Provider Data Management, driving performance across Medicaid, Medicare, and Commercial lines.

You will align strategy with reimbursement methodologies, develop education programs for providers, mentor division leaders, and collaborate with IT, Analytics and Finance to ensure data integrity, regulatory compliance and strong provider

Qualifications

• Minimum 8 years of leadership experience in healthcare provider network operations.
• Strong knowledge of provider reimbursement methodologies and compliance requirements.
• Bachelor’s degree in business, healthcare administration, finance or related field.

Responsibilities

• Oversee Provider Network Operations including Provider Relations, Credentialing and Data Management.
• Lead cross‑department planning to maintain enterprise‑level KPIs across Medicaid, Medicare, and Commercial lines.
• Develop and execute provider education programs and relationship management strategies.
• Collaborate with IT, Analytics, Finance and Health Services to ensure interoperability and compliance.

Skills

Provider network operations

Provider relations

Credentialing

Data management

Strategic leadership

HIPAA compliance

Financial acumen

Team leadership

Stakeholder management

Project management

Education

Bachelor’s degree in business/health care administration

Associate’s degree + 2 years relevant experience

Tools

EMR systems

Healthcare data platforms

Job description

PacificSource seeks a seasoned senior leader to head Provider Network Operations in North Carolina. You will oversee Provider Relations, Credentialing, and Provider Data Management, driving performance across Medicaid, Medicare, and Commercial lines.

You will align strategy with reimbursement methodologies, develop education programs for providers, mentor division leaders, and collaborate with IT, Analytics and Finance to ensure data integrity, regulatory compliance and strong provider