PacificSource Health Plans

Director of Provider Network

Job Location US-WA-Tacoma
Job ID
Regular Full-Time
Hiring Pay Range
95,000 - 125,000 / year
# of Openings


Oversee provider contracting, provider relations, provider partnerships, provider network development, and strategic initiative deployment in assigned territory for PacificSource Health Plans.  Work with senior leadership in Health Services, Finance, Sales and Government Programs to develop key strategies with maximum positive impact.  Deploy resources and oversee key work processes to achieve critical goal attainment across all lines of business including commercial, Medicare and Medicaid.  Work collaboratively with senior leadership in Finance, Operations, AUA, Sales, IT, Health Services, Revenue ,Government Programs, and across teams in Provider Network – as well as external contracted vendors, and external provider partners.


  1. Manage contracting processes of IPAs, physicians, hospitals and other providers, including risk models, fee-for-service reimbursement, innovative payment methodologies, and aligned incentive models with provider partners.
  2. Manage network development processes with key provider partners in conjunction with constituents within PacificSource including health care exchange leaders, government sales and marketing, commercial sales, and product development staff.
  3. Manage provider relations activities including workshops, provider transactional support, responsiveness to provider inquiries, strategic activity deployment, including EHR access, 5-star enhancements, clinical enhancement deployment (MyCare visits), medical record access, transactional efficiency, provider communications, policy deployment, Provider Manual activities, and other activities of key strategic importance between PacificSource and its external provider network.  
  4. Manage key provider partnerships whether created as part of CCO collaborations, aligned risk models, or through mutually agreed upon partnership agreements.
  5. Manage processes with staff and leaders in intradepartmental activities such as compliance activities, fee schedule implementation, managing phone queue, internal audit activities, credentialing activities, policy formation and project management.
  6. Manage vendor relations and activities to meet department goals. Develop and implement business plan to replace vendor activities using internal staff, where possible.
  7. Responsible for positive departmental culture as it relates to opportunities for improvements in prior department engagement and culture survey results.
  8. Responsible for oversight, management, development, implementation, and communication of department programs and activities.
  9. Responsible for hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. Provide feedback, including regular one-on-one meetings and performance evaluations for direct reports.
  10. Develop annual department budgets. Monitor spending versus the planned budget throughout the year and take corrective action where needed.
  11. Actively participate as a key team member in Manager/Supervisor meetings, as well as PRISM walks and other key department activities. Actively participate in committees as appropriate and in conjunction with other department leaders.    
  12. Actively participate in various strategic and internal committees in order to disseminate information within the organization and represent company philosophy.

Supporting Responsibilities:

  1. Interact with staff in internal departments such as Finance, Revenue, Health Services, Sales, Communications, IT, AUA, Government Programs and Compliance. Coordinate business activities by maintaining collaborative partnerships with key departments.
  2. Assess new and innovative provider payment methodologies for approval and implementation.
  3. Meet department and company performance and attendance expectations.
  4. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  5. Perform other duties as assigned.


Work Experience: 5 years in healthcare and 3 years in provider contracting, provider relations, or provider network operations required.


Education, Certificates, Licenses: Bachelor’s Degree in related field required.


Knowledge: Advanced knowledge of provider reimbursement and reimbursement methodologies, provider relations, or provider partnership activities in relevant markets and geography. 




Our Values

  • Authenticity
  • Building Organizational Talent
  • Empowerment/Delegation
  • Customer Focus
  • Emotional Intelligence
  • Compelling Communications
  • Managing Conflict
  • Passion for Results  
  • Coaching and Developing Others
  • Operational Decision Making
  • We are committed to doing the right thing.
  • We are one team working toward a common goal.  
  • We are each responsible for our customers’ experience.
  • We practice open communication at all levels of the company to foster individual, team and company growth.
  • We actively participate in efforts to improve our many communities, internal and external.
  • We encourage creativity, innovation, continuous improvement, and the pursuit of excellence.


Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time.


Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. 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. Communicate clearly and effectively.


Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.


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, national origin, sex, sexual orientation, gender identity or age.



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