Director, Provider Network Operations

This is a fully remote position, open to applicants in Florida.

📋 Description

• Oversee Provider Network Operations encompassing Provider Relations, Provider Data Management, Credentialing, and the interoperability of provider platforms.

• Direct strategic initiatives for network establishment and upkeep, ensure provider data accuracy, facilitate provider education, implement contracts, manage provider-related claims, conduct audits, devise corrective action plans, and maintain directory precision.

• Collaborate with teams focused on reimbursement insights and analytics to achieve objectives.

• Create and implement objectives for the Credentialing division, ensuring compliance and operational excellence.

• Formulate provider education and relationship management strategies aimed at enhancing provider collaboration, engagement, and satisfaction.

• Spearhead the integration and operational efficiency of provider network platforms with both legacy and emerging systems.

• Collaborate with software vendors, IT teams, and internal stakeholders to enhance interoperability and streamline operations.

• Identify gaps in interoperability and create solutions to improve system compatibility.

• Ensure compliance of systems with state, federal, NCQA, and organizational standards.

• Develop automated workflows and synchronize data across various platforms and departments.

• Enhance functionality utilizing LEAN methodologies and resources.

• Engage in strategic planning, execution, resource allocation, and performance monitoring.

• Work alongside executive leadership to align processes, technology, and human resources with performance and efficiency goals.

• Supervise provider collaborative initiatives and division business plans.

• Design and implement provider education programs that cover network policies, reimbursement processes, and regulatory obligations.

• Evaluate provider feedback and execute improvements in relationships.

• Collaborate with Operations, IT, Health Services, Analytics, Finance, and other departments.

• Manage annual IT work plans, initiative work plans, budgets, and resource requirements for supervisory departments.

• Develop coaching and training programs in conjunction with division leaders.

• Oversee recruitment, staff development, coaching, performance evaluations, and employee engagement.

• Manage division budgets, expenditures, and corrective actions.

• Participate in manager and supervisor meetings, PRISM walks, internal committees, and departmental activities.

• Evaluate innovative provider payment methodologies for approval and implementation.

• Meet departmental and company performance and attendance standards.

• Perform additional duties as assigned.

⛳️ Requirements

• At least 8 years of experience in a leadership capacity overseeing healthcare provider network operations or similar functions.

• Strong preference for experience leading at least two areas: Provider Relations, Credentialing, and Provider Data Management.

• Proven experience managing large, multi-tiered teams and complex operational portfolios.

• Knowledge of provider reimbursement methodologies, provider network operations, compliance standards, and healthcare data management.

• Experience in developing and executing strategies within a matrixed organization is preferred.

• Bachelor’s degree in business, healthcare administration, finance, or a related field is required.

• Candidates holding an associate’s degree with 2 years of relevant experience, or a high school diploma with 4 years of relevant experience, alongside the required minimum years of work experience, will also be considered.

• Advanced understanding of provider reimbursement practices, methodologies, provider relations, or partnership activities.

• Capability to lead teams in a matrixed organizational structure and build high-performing teams.

• Demonstrated experience in collaborative interactions with provider leaders.

• Accountable leadership with business and financial acumen, empowerment, influential communications, situational leadership, and strategic planning skills.

• Proficient in reading and understanding both written and spoken English.

• Strong ability to communicate clearly and effectively.

• Ability to perform physical tasks such as stooping, bending, sitting or standing for extended periods, repetitive motions, and lifting or carrying files and business materials.

• Travel is required approximately 15% of the time.

• Must adhere to PacificSource privacy policies and HIPAA regulations regarding confidentiality and security of protected health information.

🏝️ Benefits

• Equal opportunity employer dedicated to diversity, equity, inclusion, and social justice.

• Employee engagement initiatives and cultural enhancements.

• Coaching and training programs available.

• Opportunities for professional and staff development.