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Director, Provider Network Operations
PACIFICSOURCECore 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 strategies for provider education, compliance, and operational excellence while leading high-performing teams in a matrixed organization.
Highest-signal resume keywords
Provider Network Operations LeadershipProvider Reimbursement MethodologiesCredentialing Compliance ManagementStrategic Planning and ExecutionTeam Development and Coaching
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, audits, corrective action plans, and directory accuracy
- Collaborate with reimbursement insights and analytics teams to meet objectives
- Direct Credentialing division efforts for compliance and operational excellence
- Develop strategies for provider education, relationship management, collaboration, engagement, and satisfaction
- Lead integration and 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 streamline operations
- Ensure 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 on processes, technology, people resources, performance metrics, and efficiency targets
- Oversee provider collaborative efforts and guide functional leaders in developing 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; oversee resource prioritization and competency development
- Hire, develop, coach, and evaluate staff and enhance employee engagement
- Oversee division budgets and spending and take corrective action as needed
- Assess innovative provider payment methodologies for approval and implementation
- Participate in manager/supervisor meetings, PRISM walks, internal committees, and department activities
- Follow privacy policy and HIPAA requirements; perform other assigned duties
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 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
- 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 lightly lift and carry files and business materials
Benefits
Comp & perks- Equal opportunity employment
- Travel approximately 15% of the time
- General office setting with ergonomically configured equipment
- 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 ManagementHealthcare Data ManagementOperational ExcellenceLEAN MethodologiesContract ImplementationPerformance Metrics DevelopmentProvider Education Program DesignBudget ManagementCorrective Action PlansInteroperability Improvement
Soft Skills
Effective CommunicationCollaborative InteractionTeam LeadershipRelationship ManagementEmployee Engagement
Tools & Technologies
Provider Network PlatformsIT SystemsAnalytics ToolsFinancial Budgeting SoftwareAutomated Workflow Systems
Industry Keywords
Healthcare ComplianceNCQA StandardsProvider RelationsProvider Partnership ActivitiesMatrixed Organization