PacificSource Health Plans

  • Manager of Operations

    Job Location US-OR-Bend
    Job ID
    Regular Full-Time
    Hiring Pay Range
    # of Openings
  • Overview

    Manage operational aspects of Provider Network Department including all aspects of team and individual proficiency in areas such as:  provider data management, ensuring data integrity, compliance, reporting, internal audit, the emerging importance of encounter data impacts, provider and provider network evaluation, set-up and maintenance, and claims and other production queues.  Strong focus on data optimization/extraction/taxonomy for current and future business needs across all lines of business.  Work collaboratively with leadership in Provider Network Department, as well as many other external departments and cross-functional teams. 




    1. Oversee management of Provider Operations team and core functions pertaining to provider data/database and other information accuracy, provider set-up functions and accuracy, provider claims adjudication activities, provider directory interfaces, phone queue management, and process improvement activities to ensure efficient and effective operations.  
    2. Oversee management of compliance findings and corrective actions, internal audit activities, and some provider reporting accountabilities.  
    3. Manage processes with staff and leaders in intradepartmental activities resulting from compliance activities, provider set up and fee implementation, managing phone queue, internal audit activities, policy formation and documentation/training.   
    4. 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.
    5. Collaborate with department leaders including Credentialing, Service, Project Management, IPN and Contracting.
    6. Evaluate custom network assessments to assist decision-making for new sales opportunities.  
    7. Focus on next-level operational performance including data taxonomy, data optimization, data extraction, and other data uses including provider directory needs, using Facets or other provider data repositories.
    8. Perform and participate in daily huddles to manage daily operational performance and collaboration, as well as to highlight team accomplishments.      
    9. 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.
    10. Develop annual department budgets. Monitor spending versus the planned budgeted throughout the year and take corrective action where needed.
    11. Actively participate as a key team member in Manager/Supervisor meetings and other internal committees, including the sharing of pertinent information back to the department.
    12. Assess technology improvements via process improvement activities and pilots, as well as via vendor and other technology solutions.
    13. Assess satisfaction of operational activities as measured by intradepartmental and interdepartmental customers.


    Supporting Responsibilities:

    1. Meet department and company performance and attendance expectations.
    2. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
    3. Perform other duties as assigned.


    Work Experience: 5 years in healthcare or healthcare operations, and 3 years of management overseeing operational areas.  Experience in the management of provider data preferred. 


    Education, Certificates, Licenses: Bachelor’s Degree in related field or equivalent combination of education and experience.


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



    Our Values

    •   Building Trust
    •   Building a Successful Team
    •   Aligning Performance for Success
    •   Customer Focus
    •   Continuous Improvement
    •   Facilitating Change
    •   Leveraging Diversity
    •   Driving for Results  
    •   Building  Partnerships
    •   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 customer’s 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 Health Plans 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, age.




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