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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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 leading healthcare provider network operations, focusing on provider relations, credentialing, and data management. Proven ability to develop strategies that enhance provider collaboration, ensure compliance, and optimize operational effectiveness across diverse teams and systems.
Highest-signal resume keywords
Provider Network Operations LeadershipProvider Relations ManagementCredentialing Strategy DevelopmentHealthcare Data ManagementCompliance with NCQA and Regulatory Standards
About the role
Key responsibilities & impact- Lead Provider Network Operations across Provider Relations, Provider Data Management, Credentialing, and provider platform interoperability
- Guide strategic initiatives for network setup and maintenance, provider data integrity, provider education, contract implementation, provider-related claims, audits, corrective action plans, and directory accuracy
- Collaborate with reimbursement insights and analytics teams to meet objectives
- Develop and execute Credentialing division objectives, ensuring compliance and operational excellence
- Develop provider education and relationship management strategies to improve provider collaboration, engagement, and satisfaction
- Lead integration and operational effectiveness of provider network platforms with legacy and emerging systems
- Partner with software vendors, IT teams, and internal stakeholders to optimize interoperability and streamline operations
- Identify interoperability gaps and develop solutions to enhance system compatibility
- Ensure systems comply with state, federal, NCQA, and organizational standards
- Develop automated workflows and synchronize data across platforms and departments
- 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 people resources with performance and efficiency targets
- Oversee provider collaborative efforts and division business plans
- Design and deliver provider education programs covering network policies, reimbursement processes, and regulatory requirements
- Assess provider feedback and implement relationship improvements
- Collaborate with Operations, IT, Health Services, Analytics, Finance, and other departments
- Oversee annual IT work plans, initiative work plans, budgets, and resource needs for supervisory departments
- Develop coaching and training programs with division leaders
- Oversee hiring, staff development, coaching, performance reviews, and employee engagement
- Manage division budgets, spending, and corrective actions
- Participate in manager and supervisor meetings, PRISM walks, internal committees, and department activities
- Assess innovative provider payment methodologies for approval and implementation
- Meet department and company performance and attendance expectations
- 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
- 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/carry files and business materials
- Travel required approximately 15% of the time
- Must follow PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information
Benefits
Comp & perks- Equal opportunity employer committed to diversity, equity, inclusion, and social justice
- Employee engagement programs and cultural enhancements
- Coaching and training programs
- Professional development and staff development opportunities
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 Reimbursement MethodologiesOperational ExcellenceData SynchronizationLEAN MethodologiesStrategic PlanningBudget ManagementPerformance MonitoringAutomated Workflow DevelopmentInteroperability SolutionsContract Implementation
Soft Skills
Collaborative InteractionAccountable LeadershipInfluential CommunicationSituational LeadershipTeam Building
Tools & Technologies
Provider Network PlatformsIT SystemsAnalytics ToolsHealthcare Software SolutionsPerformance Management Systems
Industry Keywords
Healthcare OperationsProvider EducationCompliance RequirementsMatrixed OrganizationProtected Health Information (PHI)