Head of Provider Network Operations

PacificSource; Georgia; Remote; USD 120,000 - 180,000; Full time

Job summary

PacificSource is seeking a senior leader to oversee Provider Network Operations, including Provider Relations, Credentialing, and Provider Data Management. This role guides network setup, data integrity, provider education, and service quality across Medicaid, Medicare, and Commercial lines.

The position requires building partnerships with IT and Operations, ensuring interoperability of systems and adherence to NCQA standards. Travel is about 15% with responsibility for large, diverse teams.

Qualifications

• Minimum of 8 years in a leadership role overseeing healthcare provider network operations or related functions.
• Experience managing large, multi-level teams and complex portfolios.

Responsibilities

• Oversee Provider Network divisions including Provider Relations, Provider Data Management, Credentialing, and provider platform interoperability.
• Lead strategic initiatives for the Provider Network Operations division in line with the company plan and values.
• Collaborate with Analytics and Operations to ensure objectives are met and compliance standards (state, federal, NCQA) are maintained.
• Develop and implement provider education programs to improve engagement and satisfaction among provider partners.
• Manage annual IT work plans, budgets, and resource needs for supervisory departments.
• Hire, coach, and assess staff; provide ongoing feedback and performance evaluations.

Skills

Leadership

Provider network operations

Compliance

Healthcare data management

Strategic planning

Cross-functional collaboration

Education

Bachelor's degree in business/healthcare administration/finance

Job description

PacificSource is seeking a senior leader to oversee Provider Network Operations, including Provider Relations, Credentialing, and Provider Data Management. This role guides network setup, data integrity, provider education, and service quality across Medicaid, Medicare, and Commercial lines.

The position requires building partnerships with IT and Operations, ensuring interoperability of systems and adherence to NCQA standards. Travel is about 15% with responsibility for large, diverse teams.