Director, Provider Network Operations & Strategy

PacificSource; North Carolina; Remote; USD 108,000 - 184,000; Full time

Job summary

PacificSource is seeking a Director of Provider Network Operations in North Carolina to lead Provider Network divisions, including Provider Relations, Credentialing, and Data Management. You will drive strategic initiatives, ensure data integrity, and coordinate with IT and analytics to optimize network platforms.

The role emphasizes cross-functional leadership, regulatory compliance, and budgeting, with a focus on delivering high performance across Medicaid, Medicare, and Commercial lines in a

Qualifications

• Minimum of 8 years of experience in a leadership role overseeing healthcare provider network operations or related functions.
• Experience leading at least two areas: Provider Relations, Credentialing, and Provider Data Management.
• Knowledge of provider reimbursement methodologies and healthcare data management.

Responsibilities

• Guide strategic initiatives for the Provider Network Operations division and oversee network setup and maintenance.
• Collaborate with analytics, credentialing, and provider relations to meet objectives and ensure compliance.
• Develop provider education programs and strengthen relationship management with provider partners.
• Lead cross-department initiatives to integrate provider network platforms with legacy and new systems.
• Ensure compliance with state, federal, NCQA standards and internal policies.
• Plan annual budgets, resources, and supervision for the Provider Network teams.

Skills

Leadership

Provider network operations

Strategic planning

Education

Bachelor's degree in business administration

Experience in healthcare administration

Job description

PacificSource is seeking a Director of Provider Network Operations in North Carolina to lead Provider Network divisions, including Provider Relations, Credentialing, and Data Management. You will drive strategic initiatives, ensure data integrity, and coordinate with IT and analytics to optimize network platforms.

The role emphasizes cross-functional leadership, regulatory compliance, and budgeting, with a focus on delivering high performance across Medicaid, Medicare, and Commercial lines in a