Director, Provider Network Operations & Strategy

PacificSource; Missouri; Hybrid; USD 108,468 - 184,396; Full time

Job summary

PacificSource is seeking a senior leader to oversee the Provider Network Operations, including Provider Relations, Credentialing, and data management. The role drives cross-departmental initiatives aligned with our strategic plan and quality standards, ensuring performance across Medicaid, Medicare, and Commercial lines.

You will guide interoperability, education, and network optimization while managing budgets and staff.

Qualifications

• Minimum of 8 years in healthcare operations required.
• Management experience required.
• Expertise in provider reimbursement methodologies, provider relations, data management and compliance; experience developing, communicating, and executing strategy in a matrixed structure.

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 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.
• Foster partnerships with software vendors and internal stakeholders to optimize interoperability of tools and streamline network operations.

Skills

Leadership

Financial acumen

Empowerment

Influential communication

Situational leadership

Strategic planning

Education

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

Job description

PacificSource is seeking a senior leader to oversee the Provider Network Operations, including Provider Relations, Credentialing, and data management. The role drives cross-departmental initiatives aligned with our strategic plan and quality standards, ensuring performance across Medicaid, Medicare, and Commercial lines.

You will guide interoperability, education, and network optimization while managing budgets and staff.