Director, Provider Network Operations
PacificSource Health Plans
Posted: 10/20/2026Director, Provider Network Operations
PacificSource Health Plans
Posted: 10/20/2026Director, Provider Network Operations
PacificSource Health Plans
Posted: 10/20/2026P
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Director, Provider Network Operations
PacificSource Health PlansCore Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates extensive experience in overseeing healthcare provider network operations, including Provider Relations, Credentialing, and Provider Data Management. Proven ability to develop and execute strategic initiatives while ensuring compliance with regulatory standards and enhancing provider relationships.
Highest-signal resume keywords
Provider Network Operations ManagementProvider Relations LeadershipCredentialing Strategy DevelopmentHealthcare Compliance KnowledgeTeam Leadership in Matrixed Organizations
About the role
Key responsibilities & impact- Oversee Provider Network divisions including Provider Relations, Provider Data Management, Credentialing, and provider platform interoperability
- Guide strategic initiatives for network setup and maintenance, provider data integrity, provider education and service, contract implementation, provider-related claims, provider audits, corrective action plans, and directory accuracy
- Collaborate with reimbursement insights and analytics teams to meet objectives
- Develop and execute Credentialing, provider education, and relationship management strategies
- Lead integration and operational effectiveness of provider network platforms with legacy and emerging systems
- Partner with software vendors, IT teams, and internal stakeholders to improve interoperability and system compatibility
- Ensure integrated systems comply with state, federal, NCQA, and organizational standards
- Develop automated workflows for accurate cross-platform data synchronization
- Improve functionality through LEAN methodologies and resources
- Participate in strategic planning, execution, resource allocation, and performance monitoring
- Work with executive leadership to align processes, technology, and staffing with performance and efficiency targets
- Oversee provider collaborative efforts and guide division leaders in business planning
- Design and deliver provider education programs
- Assess provider feedback and implement relationship improvements
- Oversee annual IT and initiative work plans, financial budgets, and resource needs
- Develop coaching and training programs and oversee resource prioritization
- Hire, develop, coach, and conduct performance reviews for direct reports
- Enhance employee engagement within Provider Network
- Oversee division budgets and spending and implement corrective actions
- Participate in manager/supervisor meetings, PRISM walks, internal committees, and department activities
- Assess innovative provider payment methodologies
- Follow privacy policy and HIPAA requirements and perform other duties as assigned
Requirements
What you’ll need- Minimum of 8 years of experience in a leadership role overseeing healthcare provider network operations or related functions
- Experience leading at least two of Provider Relations, Credentialing, and Provider Data Management strongly preferred
- Demonstrated experience managing large, multi-level teams and complex operational portfolios
- Knowledge of provider reimbursement methodologies, provider network operations, compliance requirements, and healthcare data management
- Experience developing and executing strategy within a matrixed organization preferred
- Bachelor’s degree in business, health care administration, finance, or related field 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
- Advanced knowledge of provider reimbursement and reimbursement methodologies, provider relations, or provider partnership activities
- Ability to lead people in a matrixed organization structure and build high performing teams
- Proven collaborative interaction experience with provider leaders
- Ability to read and comprehend both written and spoken English
- Communicate clearly and effectively
- Ability to stoop and bend, sit and/or stand for extended periods, perform repetitive motions, and lift and carry files and business materials
Benefits
Comp & perks- Equal opportunity employment
- Travel required approximately 15% of the time
- Coaching and training programs
- Employee engagement education/programs and cultural enhancements
- At-will employment
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Provider Data ManagementProvider Reimbursement MethodologiesOperational EffectivenessData Synchronization AutomationLEAN MethodologiesStrategic PlanningPerformance MonitoringBudget ManagementContract ImplementationProvider Education Program Development
Soft Skills
Effective CommunicationCollaborative InteractionCoaching and TrainingEmployee EngagementRelationship Management
Tools & Technologies
Provider Network PlatformsInteroperability SystemsAnalytics ToolsFinancial Budgeting SoftwarePerformance Monitoring Systems
Industry Keywords
Healthcare Provider NetworkNCQA StandardsHIPAA ComplianceProvider AuditsCorrective Action Plans