Director, Provider Network Operations

PacificSource Health Plans

. Oversee Provider Network divisions including Provider Relations, Provider Data Management, Credentialing, and provider platform interoperability .

Posted 10/26/2026full-timeRemote • Virginia • United StatesLead💰 $108,469 - $184,397 per yearWebsite

Core Competencies

Role fit

Core Competencies

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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 state, federal, and NCQA standards.

Highest-signal resume keywords

Provider Network Operations LeadershipProvider Reimbursement MethodologiesStrategic Planning and ExecutionTeam Development and Performance ManagementHealthcare Compliance Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Provider RelationsCredentialingProvider Data ManagementHealthcare Data ManagementOperational ExcellenceLEAN MethodologiesAutomated WorkflowsFinancial Budget ManagementPerformance MonitoringMatrixed Organization Strategy

Soft Skills

Collaborative InteractionInfluential CommunicationAccountable LeadershipEmpowermentSituational Leadership

Tools & Technologies

Provider Network PlatformsIT SystemsOperational ToolsPerformance Monitoring Systems

Industry Keywords

Healthcare Provider NetworkNCQA StandardsHIPAA ComplianceProvider Education ProgramsProvider Directory Accuracy

About the role

Key responsibilities & impact

Oversee Provider Network divisions including Provider Relations, Provider Data Management, Credentialing, and provider platform interoperability
Guide strategic initiatives covering network setup and maintenance, provider data integrity, provider education and service, contract implementation, provider-related claims, provider setup and audits, corrective action plans, and provider directory accuracy
Collaborate with Provider Reimbursement Insights and Analytics to meet objectives
Develop, direct, and execute Credentialing division objectives for compliance and operational excellence
Develop and execute provider education and relationship-management strategies
Lead integration and ongoing operational effectiveness of provider network platforms with legacy and emerging systems
Partner with software vendors, IT teams, operational leaders, and internal stakeholders to improve interoperability and system compatibility
Ensure integrated systems support state, federal, and NCQA standards and organizational policies
Develop automated workflows and improve functionality using LEAN methodologies
Participate in strategic planning, execution, resource allocation, and performance monitoring
Work with executive leadership to align processes, technology, and people resources with performance and efficiency targets
Oversee provider collaborative efforts and division business plans
Design and deliver provider education programs and address provider feedback
Collaborate with Operations, IT, Health Services, Analytics, Finance, and other departments
Oversee annual IT work plans, initiative work plans, financial budgets, and resource needs
Develop coaching and training programs with division leaders
Hire, develop, coach, and conduct performance reviews for staff and direct reports
Enhance employee engagement within Provider Network
Oversee division budgets and spending and implement corrective actions as needed
Participate in manager/supervisor meetings, PRISM walks, internal committees, and department activities
Assess innovative provider payment methodologies for approval and implementation
Perform other duties as assigned

Requirements

What you’ll need

Minimum 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
Ability to develop and execute strategy
Advanced knowledge of provider reimbursement and reimbursement methodologies, provider relations, or provider partnership activities in relevant markets and geography
Ability to lead people in a matrixed organization structure and build high performing teams
Proven collaborative interaction experience with provider leaders
Accountable leadership, business and financial acumen, empowerment, influential communications, situational leadership, and strategic planning
Ability to read and comprehend both written and spoken English
Ability to 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
Must meet department and company performance and attendance expectations
Must follow PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information

Benefits

Comp & perks

Full-time employment
Work-from-home arrangement
Equal opportunity employment
Employee engagement, education, and cultural enhancement programs
Coaching and training programs
Approximately 15% travel