Director, Provider Network Operations

PacificSource

Springfield (MA)

On-site

USD 108,000 - 184,000

Full time

5 days ago

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Benefits offered by this job

Flexible telecommute policy

Medical insurance

Vision insurance

Dental insurance

401(k) plan

Paid time off and holidays

Tuition reimbursement and training

Job summary

PacificSource is seeking a senior leader to guide Provider Network Operations, ensuring data integrity, contract implementation and provider education. The role collaborates with reimbursement analytics, IT, and other departments to align initiatives with organizational goals and compliance requirements.

Ideal candidates have 8+ years in healthcare provider network operations and a bachelor’s degree in business, health care administration or finance.

Qualifications

Experience leading healthcare provider network operations or related functions.
Strong leadership with multi-level teams and complex portfolios.
Knowledge of provider reimbursement methodologies and compliance requirements.

Responsibilities

Guide strategic initiatives for Provider Network Operations, including network setup, data integrity and audits.
Collaborate with Analytics and IT to ensure objectives are met and systems interoperable.
Develop and execute provider education and relationship management strategies.
Oversee annual IT work plans, budgets and resource allocation for supervisory departments.
Lead hiring, staff development, coaching and performance reviews.

Skills

Provider network ops

Leadership

Strategic planning

Stakeholder management

Data management

Education

Bachelor’s degree in business, health care administration, finance, or related field

Job description

Job Summary

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

Essential Responsibilities

Guide strategic initiatives for the Provider Network Operations division, including network setup and maintenance, provider data integrity, provider education and service, contract implementation performance, provider-related claims, provider setup and audits, corrective action plan assessment and closure, and provider directory accuracy improvements.
Collaborate with Provider Reimbursement Insights and Analytics Team to ensure success in meeting objectives.
Develop, direct and execute efforts to meet Credentialing division objectives, ensuring compliance and operational excellence.
Develop and execute strategies for provider education and relationship management to enhance provider collaboration, engagement, and satisfaction within the Provider Relations Team.
Lead initiatives to ensure seamless integration and ongoing operational effectiveness of provider network platforms with legacy and emerging systems.
Fostering partnerships with software vendors and internal stakeholders to optimize the interoperability of tools and streamline network operations.
Collaborate with IT teams and operational leaders to identify interoperability gaps and develop solutions to enhance system compatibility.
Ensure integrated systems support compliance with state, federal, and NCQA standards, as well as organizational policies.
Develop automated workflows and processes that ensure accurate synchronization of data across all platforms and departments.
Guiding efforts to improve functionality via the deployment of LEAN methodologies and resources.
Strengthen relationship management frameworks to ensure consistent communication and support for provider partners.
Actively participate in department strategic planning, execution, resource allocation, and performance monitoring.
Work with executive leadership to ensure processes, technology, and people resources are in place to achieve success in both key performance metrics and efficiency/stewardship targets.
Oversee and guide provider collaborative efforts in coordination with other key departments and leaders.
Guide division functional leaders to develop business plans that ensure successful initiatives have a positive impact on the member, provider partners and PacificSource.
Strengthen relationship management frameworks to ensure consistent communication and support for provider partners.
Design and deliver provider education programs to ensure understanding of network policies, reimbursement processes, and regulatory requirements.
Regularly assess provider feedback and implement enhancements to address pain points and improve relationships.
In partnership with Operations, IT, Health Services, Analytics, Finance and other departments, collaborate to maximize the alignment and value of various initiatives.
Oversee the planning of annual IT work plans, initiative work plans, financial budgets, and resource needs for the role of supervisory departments.
Develop and implement coaching and training programs with division leaders to foster team growth.
Oversee resources and prioritization of those resources as new competencies are needed when the company grows and expands into new markets.
Responsible for hiring, staff development, coaching, and performance reviews.
Provide feedback, including regular one‑on‑one meetings and performance evaluations for direct reports.
Responsible for overall employee engagement enhancement within Provider Network to include implementation of education/programs and other desired cultural enhancements.
Oversee division budgets and spending.
Monitor spending versus the planned budget throughout the year and assess appropriate corrective actions as needed.
Actively participate in Manager/Supervisor meetings, PRISM walks, internal committees and other key department activities and disseminate information as appropriate.

Supporting Responsibilities

Assess new and innovative provider payment methodologies for approval and implementation.
Meet department and company performance and attendance expectations.
Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
Perform other duties as assigned.

Success Profile

Work Experience: Minimum of 8 years of experience in a leadership role overseeing healthcare provider network operations or related functions required.

Experience leading at least two of the following areas is strongly preferred: Provider Relations, Credentialing, and Provider Data Management.

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 required.

Experience developing and executing strategy within a matrixed organization preferred.

Education: 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.

Knowledge: 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.

Competencies

Authenticity
Building Organizational Talent
Coaching and Developing Others
Compelling Communication
Customer Focus
Empowerment/Delegation
Emotional Intelligence
Leading Change
Managing Conflict
Operational Decision Making
Passion for Results

Environment

Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 15% of the time.

Skills

Accountable leadership
Business & financial acumen
Empowerment
Influential Communications
Situational Leadership
Strategic Planning

Compensation Disclaimer: The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range.

Base Range: $108,468.62 - $184,396.64

Our Values

We are committed to doing the right thing.
We are one team working toward a common goal.
We are each responsible for customer service.
We practice open communication at all levels of the company to foster individual, team and company growth.
We actively participate in efforts to improve our many communities-internally and externally.
We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements

Stoop and bend.
Sit and/or stand for extended periods of time while performing core job functions.
Repetitive motions to include typing, sorting and filing.
Light lifting and carrying of files and business materials.
Ability to read and comprehend both written and spoken English.
Communicate clearly and effectively.

Disclaimer

This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position.

Employment remains AT-WILL at all times.

PacificSource is anything but a typical health insurance company. Founded in 1933, we’re an independent, not‑for‑profit organization that puts our members, and their communities first—across Idaho, Oregon, Montana, and Washington. It's our employees who make it happen: promoting health equity and partnering with providers to deliver better access to optimal, affordable care. So yes, with PacificSource, you get to do great things.

Benefits