Manager, Provider Credentialing and Operations

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Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths. Responsible for leading provider credentialing, recredentialing, and provider data management operations across PacificSource. Ensures compliance with regulatory and accreditation requirements (e.g., NCQA), maintains provider data integrity, and drives operational excellence across credentialing and provider data functions. Partner cross-functionally to support organizational goals, improve processes, and enhance data quality and reporting with a strong focus on data optimization, extraction, and taxonomy for current and future business needs across all lines of business. Demonstrate effective leadership by developing teamwork and team support, managing change and encouraging innovation, building collaborative relationships, encouraging involvement and initiative, and developing increased vision and commitment to goals. Essential Responsibilities: Responsible for hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. Provide feedback, including regular one-on-ones and performance evaluations, for direct reports. Responsible for positive departmental culture as it relates to following and modelling company values and identifying and pursuing improvements based on employee engagement survey results. Manage daily operational performance and collaboration, as well as highlight team accomplishments. Develop annual department budgets. Monitor spending versus the planned budget throughout the year and take corrective action where needed. Develop and implement adequate programs and processes ensuring complete programs that meets or exceeds requirements. Lead and manage all credentialing and recredentialing operations, ensuring compliance with NCQA, regulatory, and accreditation standards; oversee credentialing committee workflows and provider approval processes. Direct provider data management operations, including provider setup, data integrity, database maintenance, provider directory accuracy, and processes impacting claims and encounter data. Oversee internal audit activities, compliance findings, corrective action plans, and reporting requirements to ensure operational and regulatory compliance. Design, implement, and continuously improve systems, processes, and workflows to enhance efficiency, data accuracy, and audit readiness across credentialing and provider data functions. Advance data strategy initiatives, including data optimization, taxonomy, extraction, and reporting capabilities to support organizational and operational needs. Provide oversight of site surveys and medical record review processes, including associated travel, documentation, and compliance requirements. Maintain and manage delegated credentialing arrangements and support accreditation efforts, including ongoing readiness for NCQA and other regulatory reviews. Partner cross-functionally with Provider Network Contracting, Provider Relations, and other departments to align processes, improve service delivery, and support business objectives. Collaborate with internal and external stakeholders, including providers and vendor partners, to ensure accurate and effective credentialing and provider data operations. Identify, evaluate, and implement process improvements and technology solutions, including system enhancements and vendor tools (e.g., Cactus, Facets), to optimize performance and scalability. Monitor operational performance through key metrics, dashboards, and continuous improvement practices (e.g., huddles, lean methodologies) to identify trends and drive outcomes. Evaluate provider network data and reporting to support decision-making, including network assessments and business development needs. Lead, coach, and develop staff, including hiring, performance management, employee engagement, and ongoing professional development. Ensure compliance with HIPAA and confidentiality requirements in all aspects of credentialing and provider data management activities. Represent the function in leadership meetings, committees, and organizational initiatives; communicate key updates and ensure alignment across teams. Supporting Responsibilities: Meet department and company performance and attendance expec

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