Director, Provider Network Operations & Strategy

PacificSource; Clayton (NC); Remote; USD 120,000 - 180,000; Full time

Job summary

PacificSource is seeking a senior leader to oversee the Provider Network operations, including Provider Relations, Credentialing, and Data Management. You will guide cross-department planning, drive KPIs across Medicaid, Medicare, and Commercial lines, and coordinate with IT and Analytics.

You will develop education programs for providers, manage vendor partnerships, ensure regulatory compliance, and mentor division leaders to achieve strategic goals in a complex healthcare environment.

Qualifications

• 8+ years of experience in a leadership role overseeing healthcare provider network operations or related functions.
• Experience managing Provider Relations, Credentialing, and Provider Data Management.
• Bachelor’s degree in business, health care administration, finance, or related field.

Responsibilities

• Oversee Provider Network divisions including Provider Relations, Provider Data Management, Credentialing, and provider platform interoperability.
• Lead department planning and cross-department initiatives to meet performance KPIs across all lines of business.
• Collaborate with Analytics to ensure success in meeting objectives and drive credentialing objectives.
• Develop provider education programs and enhance provider engagement and satisfaction.
• Ensure interoperability of network platforms with legacy and emerging systems; manage vendor partnerships.
• Ensure compliance with state, federal, and NCQA standards and organizational policies.
• Lead budgeting, resource allocation, and performance reviews; mentor and develop division leaders.

Skills

Leadership

Provider Network Ops

Strategic Planning

Compliance

Cross-functional Leadership

Vendor Management

Data Governance

Education

Bachelor's degree in business/healthcare

Job description

PacificSource is seeking a senior leader to oversee the Provider Network operations, including Provider Relations, Credentialing, and Data Management. You will guide cross-department planning, drive KPIs across Medicaid, Medicare, and Commercial lines, and coordinate with IT and Analytics.

You will develop education programs for providers, manage vendor partnerships, ensure regulatory compliance, and mentor division leaders to achieve strategic goals in a complex healthcare environment.