Head of Legal Operations (Remote)

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! 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. This position is accountable for the Provider Network department’s core operational, data, and systems functions. This role will oversee Provider Network divisions including Provider Relations, Provider Data Management, Credentialing, and provider platform interoperability. This position leads both department-specific and cross departmental planning and execution efforts, to maintain high levels of performance in enterprise level and Provider Network level key performance indicators. This position is responsible for all lines of business (Medicaid, Medicare, Commercial) and leads in strong alignment with the company’s strategic plan, vision, and values. Guide strategic initiatives for the Provider Network Operations division, 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 Provider Reimbursement Insights and Analytics Team to ensure success in meeting objectives. Develop, direct and execute efforts to meet Credentialing division objectives, ensuring compliance and operational excellence. Develop and execute strategies for provider education and relationship management to enhance provider collaboration, engagement, and satisfaction within the Provider Relations Team. Lead initiatives to ensure seamless integration and ongoing operational effectiveness of provider network platforms with legacy and emerging systems. Fostering partnerships with software vendors and internal stakeholders to optimize the interoperability of tools and streamline network operations Ensure integrated systems support compliance with state, federal, and NCQA standards, as well as organizational policies. Develop automated workflows and processes that ensure accurate synchronization of data across all platforms and departments. Strengthen relationship management frameworks to ensure consistent communication and support for provider partners. Actively participate in department strategic planning, execution, resource allocation, and performance monitoring. Work with executive leadership to ensure processes, technology, and people resources are in place to achieve success in both key performance metrics and efficiency/stewardship targets. Guide division functional leaders to develop business plans that ensure successful initiatives have a positive impact on the member, provider partners and PacificSource. Strengthen relationship management frameworks to ensure consistent communication and support for provider partners. Design and deliver provider education programs to ensure understanding of network policies, reimbursement processes, and regulatory requirements. In partnership with Operations, IT, Health Services, Analytics, Finance and other departments, collaborate to maximize the alignment and value of various initiatives. Oversee the planning of annual IT work plans, initiative work plans, financial budgets, and resource needs for the role of supervisory departments. Develop and implement coaching and training programs with division leaders to foster team growth. Responsible for hiring, staff development, coaching, and performance reviews. Provide feedback, including regular one-on-one meetings and performance evaluations for direct reports. Responsible for overall employee engagement enhancement within Provider Network to include implementation of education/programs and other desired cultural enhancements. Assess new and innovative provider payment methodologies for approval and implementation. Meet department and company performance and attendance expectations. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. Work Experience: Minimum of 8 years of experience in a leadership role overseeing healthcare provider network operations or related functions required. Provider Relations, Credentialing, and Provider Data Management. 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 required. 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. Building Organizational Talent Coaching and Developing Others Customer Focus Emotional Intelligence Managing Conflict Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 15% of the time. Accountable leadership, Business & financial acumen, Empowerment, Influential Communications, Situational Leadership, Strategic Planning Compensation Disclaimer Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. In fact, our culture is driven by these seven core values which guide us in how we do business: We are each responsible for customer service. We actively participate in efforts to improve our many communities-internally and externally. We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English.