Senior Director, Provider Network Operations & Strategy

PacificSource; Athens (GA); Remote; USD 150,000 - 210,000; Full time

Job summary

PacificSource is seeking a senior leader to direct all facets of the Provider Network operations across Medicaid, Medicare and Commercial lines of business in a Georgia setting. You will oversee Provider Relations, Credentialing and Provider Data Management, and drive interoperability with legacy and new systems.

The role requires a minimum of eight years leading large teams, deep knowledge of reimbursement methods, and a track record of improving provider engagement and compliance with NCQA

Qualifications

• Minimum of 8 years in a leadership role overseeing healthcare provider network operations.
• Experience with Provider Relations, Credentialing and Provider Data Management.
• Knowledge of provider reimbursement methodologies and healthcare data management.
• Strong strategic planning and cross-functional leadership abilities.

Responsibilities

• Oversee Provider Network divisions including Provider Relations, Provider Data Management, Credentialing, and platform interoperability.
• Lead strategic initiatives for Provider Network Operations and ensure enterprise KPI targets.
• Develop education programs and relationship management to enhance provider collaboration and satisfaction.
• Ensure compliance with state, federal, NCQA standards and privacy/HIPAA policies.
• Collaborate with IT, Operations and Finance to align initiatives and manage annual work plans.
• Hire, coach, and evaluate staff; drive employee engagement.
• Build data synchronization workflows across platforms.
• Travel approximately 15%.

Skills

Provider Relations

Credentialing

Provider Data Management

Leadership

Education

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

Associate’s degree with 2+ years of relevant experience or high school diploma with 4+ years experience

Job description

PacificSource is seeking a senior leader to direct all facets of the Provider Network operations across Medicaid, Medicare and Commercial lines of business in a Georgia setting. You will oversee Provider Relations, Credentialing and Provider Data Management, and drive interoperability with legacy and new systems.

The role requires a minimum of eight years leading large teams, deep knowledge of reimbursement methods, and a track record of improving provider engagement and compliance with NCQA