Director, Provider Data Management

CareOregon•Portland, OR

5d•$155,430 - $189,970•Hybrid

About The Position

This position is responsible for enterprise leadership and strategic oversight of CareOregon’s provider network data management, including provider data management and credentialing. Primary duties include strategic and operational leadership and planning, as well as resource, relationship, and people management. The Director ensures cohesive operations support, timely and accurate provider data configuration, credentialing oversight, and overall operational excellence across Medicaid and Medicare lines of business. This position is also accountable for ensuring all plan operations are compliant with OHA, CMS, and NCQA standards as applicable. This position is required to be in the downtown Portland office 3x/week. We are looking for candidates in the Portland Metro area.

Requirements

Minimum 10 years’ experience in health plan operations, provider network engagement and/or hospital or medical staff credentialing.
Strong understanding of Medicaid in a managed care environment
Understanding of claims, provider directories and provider data
Understanding of how to manage a production-oriented workforce
Understanding of credentialing policies & practices
Understanding of network regulatory reporting, including DSN and HSD tables
Knowledge of federal Medicare regulations and state Medicaid rules (OARs)
Skilled in strategic thinking and executing strategy effectively; ability to think at an enterprise level
Leadership effectiveness and ability to design and implement constructive change
Strong people management skills, including the ability to coach and motivate teams
Excellent critical thinking, analytical and problem-solving skills; ability to effectively analyze program goals and objectives to determine successes and opportunities for improvement
Ability to effectively convey business unit goals and plans ensuring integration into strategic plans and initiatives
Highly skilled in resource management
Ability to communicate effectively, both verbally and in writing, including strong presentation and change management skills
Ability to influence and build consensus
Ability to work in an environment with matrix reporting, diverse individuals and groups
Ability to work effectively with diverse individuals and groups
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

Nice To Haves

Minimum 4 years’ supervisory experience
Management experience in a managed care organization or provider practice setting
Provider relations experience

Responsibilities

Provide strategic leadership for provider data management, including credentialing, and provider data.
Develop and oversee execution of proactive strategic initiatives to ensure appropriate network development and wholistic provider data management.
Ensure network practitioners are credentialed per plan policies.
Ensure provider data systems are optimized to enable strategic network management, including accurate and timely claims processing and directory presentation.
Effectively use business intelligence and data analytics to monitor network data accuracy, forecast system changes and overall plan data needs.
Ensure compliance with federal, state, and contractual requirements.
Identify and implement process improvement activities to improve department productivity.
Ensure documented policies and procedures are established and maintained to ensure accurate, efficient, and compliant operations.
Remain current with healthcare industry trends, best practices, and approaches to drive efficient and compliant network operations.
Develop budgets in alignment with strategic planning.
Ensure teams have sufficient resources to perform their work.
Ensure budgets are monitored and managed effectively across areas of oversight.
Approve resource allocations within budget, including people, finances, and timelines.
Ensure strategic messages are regularly and effectively relayed to management team and staff; promote transparency.
Collaborate with leaders across the organization in identifying integrated improvement strategies and ensuring meaningful integration.
Direct team(s) and establish team direction and goals in alignment with the organizational mission, vision, and values.
Identify work and staffing models; recruit, hire, and oversee a team to meet work needs, using an equity, diversity, and inclusion lens.
Identify department priorities; ensure employees have information and resources to meet job expectations.
Lead the development, communication, and oversight of team and individual goals; ensure goals, expectations, and standards are clearly understood by staff.
Manage, coach, motivate, and guide employees; promote employee development.
Evaluate employee performance and provide regular feedback to support success; recognize strong performance and address performance gaps and accountability (corrective action).
Perform supervisory tasks in collaboration with Human Resources as needed.
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.

Benefits

competitive pay
bonus opportunity
medical insurance
dental insurance
vision insurance
life insurance
AD&D insurance
disability insurance
health savings account
flexible spending account(s)
lifestyle spending account
employee assistance program
wellness program
discounts
multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.)
strong retirement plan with employer contributions
PTO
Paid State Sick Time
paid holidays
volunteer time
jury duty
bereavement leave