Head of Provider Network Operations & Strategy

PacificSource; Atlanta (GA); On-site; USD 108,000 - 184,000; Full time

Job summary

PacificSource seeks a seasoned leader to oversee Provider Network operations, including Provider Relations, Credentialing, and Provider Data Management. The role drives strategy, interoperability across platforms, and performance across Medicaid, Medicare, and Commercial lines.

Responsibilities include guiding education programs, managing vendor partnerships, and aligning resources with strategic goals. This role requires executive leadership, experience with HIPAA and NCQA standards, and a

Qualifications

• Minimum 8 years of leadership experience in healthcare provider network operations or related functions.
• Experience leading Provider Relations, Credentialing, and/or Provider Data Management preferred.
• Knowledge of provider reimbursement methodologies and healthcare data management.
• Experience building and leading large, matrixed teams.

Responsibilities

• Guide strategic initiatives for the Provider Network Operations division, including network setup and maintenance and data integrity.
• Develop and execute strategies for provider education, engagement, and relations.
• Lead integration of provider network platforms with legacy and emerging systems.
• Collaborate with IT and operations to ensure interoperability and compliance with standards.
• Oversee budgets, staffing, and performance monitoring; participate in strategic planning.

Skills

Accountable leadership

Business & financial acumen

Empowerment

Influential Communications

Situational Leadership

Strategic Planning

Education

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

Job description

PacificSource seeks a seasoned leader to oversee Provider Network operations, including Provider Relations, Credentialing, and Provider Data Management. The role drives strategy, interoperability across platforms, and performance across Medicaid, Medicare, and Commercial lines.

Responsibilities include guiding education programs, managing vendor partnerships, and aligning resources with strategic goals. This role requires executive leadership, experience with HIPAA and NCQA standards, and a