Provider Relations Specialist II

CareOregon • Medford, OR

2d • $66,690 - $81,510 • Hybrid

About The Position

The Provider Relations Specialist II serves as a primary liaison between CareOregon and its contracted, non-contracted, and potential provider partners. The role focuses on building and strengthening relationships with contracted providers through intermediate-level provider onboarding, development, education, and relations. It collaborates with internal teams to identify network needs and gaps, resolve issues, and ensure contract and regulatory requirements are met. The position also supports contract development, site visits, and department administration, with work potentially focused on physical, behavioral, and/or community-based healthcare networks.

This position serves the Jackson Care Connect community and is intended for candidates located near or within commuting distance of Medford. It is hybrid, with a requirement to work in the office or community one to two times per week. The role requires travel outside the workplace at least weekly; the employee’s personal vehicle may be used. Work environments include an indoor office, community settings, and outdoor exposure. The position uses general office equipment.

Requirements

• At least 4 years of relevant experience relating to physical and/or behavioral health, including involvement in several of the following: provider relations, managed care operations such as claims, appeals, grievances, or customer service; medical or behavioral health clinic operations; or related healthcare 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 networks in physical and/or behavioral health and medical clinic operations.
• Proficiency with Microsoft Office, including Word, Excel, and Outlook.
• Excellent listening, verbal, and written communication skills; strong service orientation; and skill in conducting training and presentations.
• Ability to develop and maintain professional relationships with providers, provider staff, and internal colleagues; clearly communicate policies, instructions, goals, and objectives; and provide concise information.
• Ability to coach others, serve as an effective resource, and work independently and collaboratively.
• Ability to organize, prioritize, and manage multiple projects; develop and revise policies and procedures; and problem-solve with diverse providers and provider groups.
• Ability to work with diverse individuals and groups; learn, focus, understand, and evaluate information; and determine appropriate actions.
• Ability to accept direction and feedback and tolerate and manage stress.
• Ability to see, read, hear, and speak clearly; perform repetitive finger and wrist movements for at least 6 hours per day; sit for up to 8 hours per day; occasionally lift and carry for 1–3 hours per day; and operate a motor vehicle.
• Ability to work in the office or community one to two times per week and travel outside the workplace at least weekly.

Responsibilities

• Develop and maintain effective working relationships across the provider network and communicate knowledge of network eligibility and support.
• Contribute to new provider contract determinations and oversight; conduct provider orientations and train clinic office staff on CareOregon administrative processes.
• Conduct group training sessions and presentations with minimal supervision.
• Engage contracted providers in an assigned area to develop, address, and monitor network needs and strengthen provider experience, member access to quality care, and healthcare transformation.
• Conduct provider site visits and complaint visits as needed; research provider questions, connect providers to resources, resolve underlying issues, and address contractual concerns.
• Handle provider complaints involving contracted and non-contracted entities, including primary care providers, specialists, hospitals, and vendors.
• Serve as a liaison to clinics regarding standard reporting, including capacity, financial, member assignment, utilization, and referral-partner information.
• Participate in interdepartmental initiatives and teams, facilitate large and complex provider meetings, attend CareOregon events, and participate in Clinical Advisory Panel meetings.
• Coordinate with Claims, Credentialing, Provider Data, and other departments on processes and provider issues, including Peer Review.
• Identify potential providers who may enhance the network; obtain and review provider application data and submit it to provider contracting staff.
• Support the Contracting team in facilitating provider contract terminations.
• Contribute to the development of relevant policies and procedures; participate in department meetings and provide input on program development and initiatives.
• Mentor new team members and serve as a resource as needed.
• Perform work in alignment with CareOregon’s mission, vision, and values; support equity, diversity, and inclusion; strive to meet annual business goals; comply with organizational policies and requirements; and perform other duties as needed.

Benefits

• Competitive pay and bonus opportunity.
• Medical, dental, vision, life, AD&D, and disability insurance for eligible employees.
• Health savings account, flexible spending accounts, and lifestyle spending account.
• Employee assistance program and wellness program.
• Discounts and supplemental benefits, including voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, and 529 College Savings.
• Retirement plan with employer contributions.
• For benefits-eligible employees, PTO and Paid State Sick Time based on hours worked or scheduled hours and primary work state.
• Potential paid holidays, volunteer time, jury duty, bereavement leave, and other leave, depending on eligibility.
• For non-benefits-eligible employees, 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed