Head of Provider Network Operations

PacificSource Health Plans; Lorida (FL); Remote; USD 150.000 - 190.000; Vollzeit

Zusammenfassung

PacificSource Health Plans seeks a strategic leader for Provider Network Operations to drive performance across Provider Relations, Credentialing, and Data Management. The role aligns network operations with enterprise strategy, ensuring data integrity and education programs for providers.

The position oversees cross-department initiatives, maintains compliance with state and federal standards, and partners with IT and analytics to optimize interoperability of network tools and platforms.

Qualifikationen

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

Aufgaben

• Oversee Provider Network department’s core operational, data, and systems functions.
• Lead Provider Relations, Credentialing, and Provider Data Management.
• Ensure compliance and operational excellence across Medicaid, Medicare, and Commercial lines.
• Collaborate with cross-functional teams to achieve KPIs.
• Develop and execute strategies for provider education and relationship management.
• Guide division leaders in business planning and resource allocation.
• Ensure provider data integrity and directory accuracy.

Kenntnisse

Leadership

Provider relations

Credentialing

Healthcare data management

Reimbursement methodologies

Ausbildung

Bachelor’s degree in business/healthcare administration/finance

Tools

EMR/EHR systems

Jobbeschreibung

PacificSource Health Plans seeks a strategic leader for Provider Network Operations to drive performance across Provider Relations, Credentialing, and Data Management. The role aligns network operations with enterprise strategy, ensuring data integrity and education programs for providers.

The position oversees cross-department initiatives, maintains compliance with state and federal standards, and partners with IT and analytics to optimize interoperability of network tools and platforms.