Head of Provider Network Operations

PacificSource Health Plans; Tallahassee (FL); Remote; USD 140,000 - 190,000; Full time

Job summary

PacificSource Health Plans seeks a senior leader to oversee the Provider Network operations across Provider Relations, Credentialing, and Data Management, guiding strategic initiatives and ensuring data integrity to drive performance across Medicaid, Medicare, and Commercial lines.

Reporting to executive leadership, you will build high‑performing teams, manage budgets, and partner with IT and finance to optimize systems and provider education. Travel ~15% as required.

Qualifications

• Minimum of 8 years in a leadership role overseeing healthcare provider network operations.
• Experience with Provider Relations, Credentialing, and Provider Data Management.
• Strong knowledge of reimbursement methodologies and healthcare data management.

Responsibilities

• Oversee Provider Network operations across multiple divisions to meet KPIs.
• Lead strategic planning, budgeting, and cross‑department collaboration.
• Develop education programs and provider education and relationship management.
• Ensure compliance with state, federal, and NCQA standards.
• Hire, coach, and evaluate staff; drive engagement and performance.
• Align IT and vendor partnerships to support network platforms.

Skills

Leadership

Strategic planning

Coaching

Relationship management

Communication

Education

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

Job description

PacificSource Health Plans seeks a senior leader to oversee the Provider Network operations across Provider Relations, Credentialing, and Data Management, guiding strategic initiatives and ensuring data integrity to drive performance across Medicaid, Medicare, and Commercial lines.

Reporting to executive leadership, you will build high‑performing teams, manage budgets, and partner with IT and finance to optimize systems and provider education. Travel ~15% as required.