Provider Relations Representative, Oral Health
About The Position
At Umpqua Health, we’re more than a healthcare organization—we’re a community-driven Coordinated Care Organization (CCO) dedicated to improving the health and well-being of individuals and families throughout Douglas County, Oregon. We provide integrated, whole-person care through primary care, specialty care, behavioral health services, and care coordination. Our collaborative approach ensures members receive high-quality, personalized care while supporting a stronger, healthier community. The Provider Relations Representative – Oral Health serves as the primary liaison between Umpqua Health and its delegated dental care network entity. This role provides operational oversight of the delegated contract, ensures compliance with contractual requirements, monitors performance metrics, and assists in the implementation of oral health programs. The position requires strong knowledge of dental care delivery systems, managed care principles, and the ability to collaborate with internal teams and external partners to improve access, quality, and member experience.
Requirements
- Bachelor's degree in healthcare administration, Business, Public Health, Communications, or a related field
- Minimum of 3 years of experience as a Provider Relations Representative, Network Manager, or similar role within a Medicaid MCO or dental benefits administrator
- Minimum of 5 years of hands-on experience working with dental providers (e.g., solo practices, group practices, or clinics serving Medicaid populations), including dental practice management, multi-site operations, or provider outreach
- Strong knowledge of Medicaid Managed Care principles, including provider contracting, dental claims and billing processes (CDT codes), prior authorization, and regulatory compliance standards (e.g., NCQA, HEDIS, Dental Quality Alliance measures)
- Familiarity with Oregon’s Coordinated Care Organization (CCO) model and Oregon Health Plan (OHP) dental benefits
- Proven ability to conduct provider education, training sessions, site visits, and resolve issues such as claims disputes, policy questions, and billing support
- Strong communication and relationship-building skills
- Strong analytical and problem-solving abilities, including monitoring performance metrics and compliance
- Proficiency in Microsoft Office Suite and ability to learn provider systems
- Ability to manage multiple priorities, work independently, and meet deadlines in a field-based environment
- Ability to interpret and enforce contractual requirements and regulatory standards
- Ability to collaborate effectively with internal teams and external partners
- Able to travel on-site
Nice To Haves
- Dental-related certifications
- Medicaid-specific training
- Experience with value-based care models for oral health
- Experience with delegated network oversight
- Experience supporting oral health integration initiatives (e.g., prenatal or pediatric coordination)
- Demonstrated experience working with diverse and rural provider populations
Responsibilities
- Oversee the dental care network managed by the delegated entity, ensuring compliance with contractual obligations and performance standards.
- Monitor and report on key metrics such as access, utilization, quality measures, and member satisfaction.
- Conduct regular reviews of delegated entity operations to ensure adherence to Umpqua Health policies and regulatory requirements.
- Ensure delegated entity meets all contractual requirements, including reporting, credentialing, and quality benchmarks.
- Collaborate with internal teams to address gaps in performance and implement corrective action plans when necessary.
- Maintain accurate documentation of oversight activities and prepare reports for leadership and regulatory agencies.
- Serve as a resource for oral health providers within the network, addressing inquiries and resolving issues related to claims, credentialing, and operational processes.
- Deliver training and education to providers on Umpqua Health initiatives, compliance standards, and oral health program requirements.
- Assist in the development and implementation of oral health programs aimed at improving preventive care, member engagement, and overall health outcomes.
- Support initiatives that integrate oral health with primary care and behavioral health services.
- Partner with internal departments such as Compliance, Quality, and Network Development to ensure alignment of oral health strategies with organizational goals.
- Participate in meetings with delegated entity leadership to review performance and discuss improvement opportunities.
Benefits
- Generous benefits package including vacation PTO, sick leave, federal holidays, and birthday leave
- Medical, dental, and vision insurance
- 401(k) with company match (fully vested immediately)
- Company-sponsored life insurance and additional benefits
- Fitness reimbursement program
- Tuition reimbursement and more
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
11-50 employees
