Provider Relations Specialist II

CareOregon•WFH (Oregon), OR

1d•$66,690 - $81,510•Hybrid

About The Position

This position serves as a primary liaison between CareOregon and the provider-partner network, which includes contracted, non-contracted, and potential providers. This position focuses on establishing, building, and strengthening provider-partner relationships among contracted providers. Primary responsibilities include an intermediate 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, resolutions, and ensuring contract and regulatory requirements are met. This position will assist with the contract development process, site visits, and general department administration. Work may be focused on physical, behavioral, and/or community-based healthcare networks. This is hybrid position with the expectation to be in office/community 1-2x/week. We are looking for candidates in the Portland Metro area or CPCCO counties (Tillamook, Clatsop, Columbia County). Estimated Hiring Range: $66,690.00 - $81,510.00 Bonus Target: Bonus - SIP Target, 5% Annual

Requirements

Minimum 4 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
Strong understanding of managed care and the Oregon Health Plan
Knowledge of fee schedules and healthcare payment methodologies
Strong understanding of provider network (physical and/or behavioral health)
Strong understanding of medical clinic operations
Proficient computer skills in Microsoft Office, including Word, Excel, and Outlook
Excellent communication skills, including listening, verbal, and written
Strong service orientation
Strong skills in conducting trainings and presentations
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 give concise information
Ability to coach others and serve as an effective resource
Ability to work independently and collaboratively
Ability to organize, prioritize and manage multiple projects
Ability to develop and revise policies and procedures
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 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 8 hours/day
Ability to lift and carry for 1-3 hours/day on occasion
Ability to operate a motor vehicle

Responsibilities

Develop and maintain effective working relationships across the provider network.
Develop and effectively communicate strong understanding of network eligibility and support, ensuring a high-quality provider network.
Play key role in new provider contract determinations and oversight.
Conduct new provider orientations (PCPs, Specialists, Vendors); train clinic office staff on CareOregon administrative processes.
Conduct group training sessions and make presentations with minimal supervision.
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 contracted providers to develop, address and monitor needs.
Conduct provider site visits to maintain ongoing relations and effectiveness.
Research provider questions and connect them to appropriate resources; ensure resolution to 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.
Act as a key liaison to clinics to understand and use standard reporting, including capacity, financial, member assignments, utilization, and key referral partners.
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.
Work closely with other internal departments, including Claims, Credentialing, and Provider Data; address processes that affect providers and partner in the resolution of issues, including Peer Review.
Participate in Clinical Advisory Panel (CAP) meetings.
Identify potential providers that may enhance the network.
Obtain and review provider application data; submit to provider contracting staff.
Support the Contracting team in facilitation of provider contract terminations.
Provide input and contribute to the development of relevant policies and procedures.
Actively participate in department meetings.
Consult and inform on CareOregon program development and initiatives.
Mentor new team members, serving as a resource, 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
Paid State Sick Time
paid holidays
volunteer time
jury duty
bereavement leave