Job Summary

This position operates in a team leadership capacity, assisting the supervisor(s) with essential unit functions and serving as the first level escalation and training resource to staff. This position will also support the supervisor(s) in creating and maintaining accurate documentation of policies and procedures. The Lead serves as the example of acting as a primary liaison between CareOregon and the provider network, which includes contracted, non-contracted, and potential providers. The Lead also serves as a valuable liaison and collaborator with internal CareOregon teams. This position also assists with the contract development process and general department administration. Work may be focused on physical health, behavioral health, and/or community-based provider support.

Essential Responsibilities

Provider Development & Education

• Develop and maintain effective working relationships across the provider network.
• Keep abreast of changes and advancements in the Provider Relations, Medicare, and Medicaid arenas.
• Conduct and/or support new provider orientations (PCPs, Specialists, Vendors); train clinic office staff on CareOregon administrative processes.
• Conduct group training sessions and make presentations.

Provider Relations

• Work with provider network within an identified area, with focus on high priority provider, to develop and support community-based delivery of health care services.
• Conduct provider site visits to maintain ongoing relations and effectiveness.
• Research provider questions and connect them to appropriate resources; ensure resolution of root cause of provider issues and concerns.
• Perform provider complaint resolution with contracted and non-contracted entities, including PCPs, specialists, hospitals, and vendors.
• Address contractual issues and concerns in assigned areas; conduct complaint visits as needed.
• Cultivate relationships with providers to enhance the provider experience, quality of care and healthcare transformation.
• Act as a key liaison to clinics to understand and use standard reporting, including capacity, financial, member assignments, utilization, and key referral partners.
• Perform the functions of a Provider Relations Specialist, as needed.

Internal Liaison

• Participate in interdepartmental initiatives and teams, providing knowledgeable insights and contributions, and effectively disseminating relevant information, as needed.
• Effectively facilitate large, complex provider meetings.
• Attend CareOregon events, serving as an integral team member.
• Work closely with other internal departments, including, but not limited to Claims, Utilization Management, Credentialing, Provider Data, and Contracting to address processes that affect providers and partner in the resolution of issues, including Peer Review.
• Research and resolve provider relations issues and concerns in an accurate and timely manner; especially those that are escalated from the Provider Relations team.

Contract Initiation

• Identify potential providers that may enhance the network.
• Obtain and review provider application data; submit to provider contracting staff.

Administration

• Provide input and contribute to the development of relevant policies and procedures; assist in the development and revision of policies and procedures.
• Actively participate in department meetings.
• Consult and inform on CareOregon program development and initiatives.
• Mentor team members, serving as a resource as needed.
• Conduct and/or support new employee onboarding.
• Participate in provider relations, leadership, and other work-related continuing education when offered or directed.

Employee Leadership

• Provide mentorship and leadership for a team in support of team direction and goals.
• Provide input into staffing needs; assist in recruiting and hiring staff, using an equity, diversity, and inclusion lens.
• Participate in organizing, scheduling, monitoring, reporting, and improving work; help ensure employees have information to meet job expectations and have coverage during absences.
• Contribute to the development, communication, and oversight of team and individual goals.
• Train, lead, and coach employees; may facilitate team meetings.
• Incorporate guidance from CareOregon equity tools into people leadership.
• Help monitor employee adherence to department and organizational standards, policies, and procedures.
• Assist in evaluating employee performance, providing feedback to support success, recognizing strong performance, and addressing performance gaps and accountability (corrective action).
• Perform lead tasks in collaboration with Human Resources as needed.
• Act as a resource for the Provider Relations Specialist team.

Organizational Responsibilities

• Perform work in alignment with the organization's mission, vision and values.
• Support the organization's commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
• Strive to meet annual business goals in support of the organization's strategic goals.
• Adhere to the organization's policies, procedures and other relevant compliance needs.
• Perform other duties as needed.

Experience and/or Education

Required

• Minimum 5 years' relevant experience relating to physical and/or behavioral health. Experience should include involvement in several of the following areas: Provider relations, managed care operations (e.g., claims, appeals, grievances, customer service), medical/behavioral health clinic operations, and/or related health care functions
• Experience with people and/or project leadership
• Valid driver's license, acceptable driving record, and automobile liability coverage or access to an insured vehicle

Preferred

• Experience in facilitating large, complex team/group meetings

Knowledge, Skills and Abilities Required

Knowledge

• Understanding of provider development, education, and relations
• Strong knowledge and understanding of Medicare, managed care, and the Oregon Health Plan
• Strong knowledge of fee schedules and healthcare payment methodologies
• Strong understanding of provider network support (physical health, behavioral health, and/or community-based)
• Strong understanding of medical and behavioral health clinical operations
• Knowledge of medical and behavioral health terminology

Skills and Abilities

• Strong computer application skills, including with Microsoft 365 Office products (Word, Excel, Outlook, PowerPoint, etc.), and Microsoft and Google-based internet browsers and search functions
• Strong communication skills, including listening, verbal, and written
• Skilled at conducting trainings, meetings, and presentations, both virtual and in-person
• Ability to interact and provide excellent customer service for a variety of internal and external customers with good judgment, personal initiative, and motivation, while performing assignments that may be confidential and sensitive in nature
• Strong ability to utilize and reference internal and external resources
• Strong ability to develop and maintain professional relationships with providers, provider staff and internal colleagues
• Ability to clearly articulate policies, instructions, goals, and objectives
• Ability to effectively educate and give concise information to a diverse audience
• Ability to perform basic rate calculations
• Ability to coach others and serve as an effective resource
• Ability to work independently and collaboratively with minimal supervision
• Ability to organize, prioritize and manage multiple projects
• Ability to represent the organization in public and private meetings and other gatherings related to areas of specialty
• Ability to lead in both a fully and semi-virtual environment
• Ability to problem-solve in an environment with diverse providers and provider groups

• Ability to work in an environment with diverse individuals and groups

• Ability to lead and communicate with individuals working within a matrixed reporting structure
• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, hear, speak clearly, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to sit for up to hours/day
• Ability to lift and carry for at least 1-3 hours/day on occasion
• Ability to operate a motor vehicle

Working Conditions

Work Environment(s): Indoor/Office Community Facilities/Security Outdoor Exposure

Member/Patient Facing: No Telephonic In Person

Hazards: May include, but not limited, to physical and ergonomic hazards.

Equipment: General office equipment

Travel: This position requires travel outside of the workplace at least weekly; the employee's personal vehicle may be used. Driving infractions will be monitored in accordance with organizational policy.

#LI-Hybrid

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.

Veterans are strongly encouraged to apply.

We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, ...