Shire Jobs

If you receive an offer of employment for this position, it is contingent on the satisfactory completion of a pre-employment background check, immunization review, and drug screen (including THC/Marijuana). CareOregon is a federal contractor and must comply with all federal laws.

Job Title

Senior Provider Relations Specialist - Behavorial Health

Department

Provider Relations

Exemption Status

Exempt

Requisition #

24346

Direct Reports

N/A

Manager Title

Provider Relations Supervisor

Pay & Benefits

Estimated hiring range $ 71,340 - $87,200 / year, 5% bonus target, full benefits.

www.careoregon.org/about-us/careers/benefits

Posting Notes

This role is a hybrid position with an in office and community presence. Local to Oregon or within a commutable distance to the Portland, Medford, or Columbia Pacific office.

This role will work with the Behavioral Health Provider Relations Team and other internal Behavioral Health focused teams and supports the Behavioral Health Provider Network.

Job Summary

This position serves as a primary liaison between CareOregon and the provider-partner network, which includes contracted, non-contracted, and potential providers. This position will act as a main resource for highly engaged, and often complex, contracted providers. Primary responsibilities include an advanced level of provider onboarding, development, education, and relations. This position is a valuable liaison and collaborator with internal CareOregon teams and is essential in identifying network needs, gaps, and resolutions. This position assists with ensuring contract and regulatory requirements are met, site visits completed, data reports are reviewed, and the contract development process is support. Work may be focused on physical, behavioral, and/or community-based healthcare networks.

Essential Responsibilities

Provider Development & Education

• Develops and effectively communicates strong understanding of network eligibility and maintains effective working relationships across a high performing provider network.

• Develops and effectively communicates expert understanding of network eligibility and available resources to ensure a high performing and engaged provider network.

• Key role in new provider contract determinations and oversight of eligibility criteria.

• Conduct new provider orientations (PCPs, Specialists, Vendors) and identify training opportunities for clinic office staff such as, but not limited to CareOregon administrative processes and regulatory requirements.

• Autonomously develop and lead group training sessions and presentations.

  Provider Relations

• Cultivate relationships with providers to enhance the provider experience, access to quality of care for members, and healthcare transformation.

• Engage the provider network within an identified area, with focus on highly engaged contracted providers, to develop, address, and monitor performance.

• Conduct provider site visits to maintain ongoing effective and professional relationships.

• Track, research, and resolve provider questions; ensure appropriate resources are offered and root cause of provider issues are appropriately documented and addressed.

• 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.

• Act as a key liaison to clinics to understand and use standard reporting, including capacity, financial, member assignments, utilization, and key referral partners.

• Promote and advocate for provider engagement in learning collaboratives, network trainings, and other educational spaces.

  Internal Liaison

• Participate on interdepartmental initiatives and teams, providing knowledgeable insights and contributions.

• Effectively facilitate large, complex provider meetings.

• Attend CareOregon events, serving as an integral team member.

• Collaborate closely with other internal departments, including Claims, Credentialing, Provider Data, Quality, and Innovations; address processes that affect providers and partner in the resolution of issues, including Peer Review.

• Participate in Clinical Advisory Panel (CAP) meetings.

  Contract Initiation

• Identify potential providers that may enhance the network.

• Obtain and review provider application data; submit to provider contracting staff.

• Collaborate with Contracting team in facilitation of provider contract terminations.

  Administration

• Contribute to the development and oversight of relevant policies and procedures.

• Actively participate in department meetings.

• Advocate, consult, and inform on CareOregon program development and initiatives.

• Mentor new team members, serving as a resource as needed.

  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

• Valid driver’s license, acceptable driving record, and automobile liability coverage or access to an insured vehicle

  Knowledge, Skills and Abilities Required

  Knowledge

• Advanced understanding of managed care and the Oregon Health Plan

• Strong knowledge of fee schedules and healthcare payment methodologies

• Advanced understanding of provider network (physical and/or behavioral health)

• Strong understanding of medical clinic operations

  Skills and Abilities

• Proficient computer skills in Microsoft Office, including Word, Excel, and Outlook

• Advanced communication skills, including listening, verbal, and written

• Strong service orientation

• Advanced skills in conducting trainings and presentations

• Strong ability to clearly articulate policies, instructions, goals, and objectives

• Strong ability to coach others and serve as an effective resource

• Strong ability to develop and revise policies and procedures

• Advanced ability to give concise information

• Advanced ability to work independently and collaboratively

• Advanced ability to organize, prioritize and manage multiple projects

• Advanced ability to develop and maintain professional relationships with providers, provider staff and internal colleagues

• Advanced ability to problem-solve in an environment with diverse providers and provider groups

• Advanced ability to work in an environment with diverse individuals and groups

• Advanced ability to learn, focus, understand, and evaluate information and determine appropriate actions

• Advanced 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 8 hours/day.

• Ability to lift and carry 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, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.

  Visa sponsorship is not available at this time.