Operations Director Jobs

About The Position

Requirements

• At least 8 years of experience in a leadership role overseeing healthcare provider network operations or related functions.
• 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.
• Bachelor’s degree in business, health care administration, finance, or a related field; 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 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 organizational structure and build high-performing teams.
• Proven collaborative interaction experience with provider leaders.
• Skills in accountable leadership, business and financial acumen, empowerment, influential communications, situational leadership, and strategic planning.
• Ability to read and comprehend written and spoken English and communicate clearly and effectively.

Nice To Haves

• Experience leading at least two of the following areas: Provider Relations, Credentialing, and Provider Data Management.
• Experience developing and executing strategy within a matrixed organization.

Responsibilities

• Guide strategic initiatives for Provider Network Operations, including network setup and maintenance, provider data integrity, provider education and service, contract implementation performance, provider-related claims, provider setup and audits, corrective action plan assessment and closure, and provider directory accuracy improvements.
• Collaborate with the Provider Reimbursement Insights and Analytics Team to meet objectives.
• Develop, direct, and execute efforts to meet Credentialing division objectives and ensure compliance and operational excellence.
• Develop and execute provider education and relationship-management strategies to improve provider collaboration, engagement, and satisfaction.
• Lead initiatives to integrate provider network platforms with legacy and emerging systems and maintain their operational effectiveness.
• Partner with software vendors and internal stakeholders to improve platform interoperability and streamline network operations.
• Collaborate with IT teams and operational leaders to identify interoperability gaps and develop solutions that improve system compatibility.
• Ensure integrated systems support compliance with state, federal, and NCQA standards and organizational policies.
• Develop automated workflows and processes to synchronize data accurately across platforms and departments.
• Guide functionality improvements using LEAN methodologies and resources.
• Strengthen relationship-management frameworks to ensure consistent communication and support for provider partners.
• Participate in department strategic planning, execution, resource allocation, and performance monitoring.
• Work with executive leadership to ensure processes, technology, and staffing resources support performance metrics and efficiency and stewardship targets.
• Oversee provider collaborative efforts in coordination with other departments and leaders.
• Guide division functional leaders in developing business plans and initiatives that benefit members, provider partners, and PacificSource.
• Design and deliver provider education programs covering network policies, reimbursement processes, and regulatory requirements.
• Assess provider feedback and implement improvements to address pain points and strengthen relationships.
• Collaborate with Operations, IT, Health Services, Analytics, Finance, and other departments to align and maximize the value of initiatives.
• Oversee annual IT and initiative work plans, financial budgets, and resource needs for supervisory departments.
• Develop and implement coaching and training programs with division leaders and oversee resource prioritization as new competencies are needed.
• Hire, develop, coach, and evaluate staff, including providing regular feedback and one-on-one meetings to direct reports.
• Enhance employee engagement within Provider Network through education, programs, and cultural initiatives.
• Oversee division budgets and spending, monitor actual spending against plan, and assess corrective actions as needed.
• Participate in Manager/Supervisor meetings, PRISM walks, internal committees, and other key department activities, and share information as appropriate.
• Assess new and innovative provider payment methodologies for approval and implementation.
• Meet department and company performance and attendance expectations.
• Follow PacificSource privacy policy and HIPAA requirements concerning the confidentiality and security of protected health information.
• Perform other duties as assigned.