Director, Provider Network Operations

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

📋 Description

• Supervise the divisions within Provider Network, including Provider Relations, Provider Data Management, Credentialing, and interoperability of provider platforms.

• Drive strategic initiatives related to network establishment and upkeep, provider data accuracy, provider education and service, contract implementation, provider claims, provider audits, corrective action strategies, and accuracy of provider directories.

• Formulate and implement objectives for the Credentialing division while ensuring compliance and operational excellence.

• Create strategies for provider education and relationship management to enhance collaboration, engagement, and satisfaction among providers.

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

• Collaborate with software vendors, IT departments, internal stakeholders, and operational leaders to enhance interoperability and system compatibility.

• Ensure that integrated systems meet state, federal, NCQA, and organizational standards.

• Develop automated workflows and data synchronization processes across various platforms and departments.

• Enhance functionality using LEAN methodologies and resources.

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

• Work with executive leadership on processes, technology, staffing resources, performance metrics, and efficiency targets.

• Oversee collaborative efforts among providers and other departments and leaders.

• Guide functional leaders in crafting business plans.

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

• Evaluate provider feedback and implement improvements to relationships.

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

• Manage annual IT work plans, initiative work plans, financial budgets, and resource requirements.

• Develop coaching and training programs alongside division leaders.

• Oversee recruitment, staff development, coaching, and performance reviews for direct reports.

• Foster employee engagement within the Provider Network.

• Manage division budgets and expenditures, taking corrective actions as necessary.

• Participate in manager/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.

• Adhere to privacy and HIPAA regulations and perform other assigned tasks.

⛳️ Requirements

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

• Experience leading at least two of the following: Provider Relations, Credentialing, and Provider Data Management is highly preferred.

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

• Strong understanding of provider reimbursement methodologies, provider network operations, compliance requirements, and healthcare data management.

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

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

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

• Capability to develop and execute strategic plans.

• Advanced knowledge of provider reimbursement and methodologies, provider relations, or provider partnership activities in relevant markets and regions.

• Ability to lead teams within a matrixed organization and foster high-performing teams.

• Demonstrated experience in collaborative interactions with provider leaders.

• Strong leadership accountability, business and financial acumen, empowerment, influential communication, situational leadership, and strategic planning skills.

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

• Ability to communicate clearly and effectively.

• Must comply with PacificSource privacy policies and HIPAA laws and regulations.

• Physical ability to stoop, bend, sit, and/or stand for extended periods, perform repetitive typing/sorting/filing tasks, and lightly lift and carry files and business materials.

🏝️ Benefits

• Flexible work-from-home arrangement as indicated by location field (WFH: NC).

• Travel required approximately 15% of the time.

• Commitment to equal opportunity employment.

• Programs aimed at employee engagement, education, and cultural enhancement.

• Coaching and training opportunities.

• Paid? Not specified.

• At-will employment.