Head of Provider Network Operations & Compliance

PacificSource Health Plans; North Carolina; A distancia; USD 150.000 - 230.000; Jornada completa

Descripción de la vacante

PacificSource Health Plans is seeking a senior leader to oversee Provider Network operations, including Provider Relations, Credentialing, and Data Management. You will guide strategic planning, drive network performance, and strengthen provider partnerships across Medicaid, Medicare, and Commercial business lines.

The role requires 8+ years in healthcare provider network leadership, with a strong emphasis on data integrity, reimbursement knowledge, and regulatory compliance.

Formación

• 8+ years of experience 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, provider network operations, compliance requirements, and healthcare data management.
• Bachelor’s degree in business, health care administration, finance, or related field; alternative qualifications considered as stated.

Responsabilidades

• Oversee Provider Network departments: Provider Relations, Provider Data Management, Credentialing, and provider platform interoperability.
• Lead strategic planning and execution to meet enterprise and network KPIs across Medicaid, Medicare, and Commercial lines.
• Develop provider education and relationship management strategies to enhance collaboration and satisfaction.
• Ensure interoperability of network tools with legacy and emerging systems; partner with software vendors and internal stakeholders.
• Align processes with state, federal, and NCQA standards; ensure data integrity and compliance.
• Lead workforce planning, coaching, performance reviews, and employee engagement initiatives.
• Manage annual IT and department budgets; supervise division leaders and resource allocation.
• Drive business plans to positively impact members, provider partners, and PacificSource.

Conocimientos

Provider network leadership

Provider relations

Credentialing

Healthcare data management

Strategic planning

Compliance

Budgeting/financial acumen

Educación

Bachelor's degree in business/healthcare administration/finance

Descripción del empleo

PacificSource Health Plans is seeking a senior leader to oversee Provider Network operations, including Provider Relations, Credentialing, and Data Management. You will guide strategic planning, drive network performance, and strengthen provider partnerships across Medicaid, Medicare, and Commercial business lines.

The role requires 8+ years in healthcare provider network leadership, with a strong emphasis on data integrity, reimbursement knowledge, and regulatory compliance.