Provider Relations Supervisor

CareOregon•Portland, OR

1d•Hybrid

About The Position

This position provides direct supervision for Provider Relations Specialists across three Coordinated Care Organizations, and a Medicare Advantage plan. Supports the provider relations team in triaging provider related issues with Claims, Customer Experience, Clinical Operations departments, and other lines of business leaders. This position supports the Provider Relations Specialists in their role as primary provider contact for complex provider needs within CareOregon’s physical and behavioral health networks, as well as other networks CareOregon may support through administrative or management services agreements. This position regularly interfaces with various subject matter experts across the organization, and partners with the Provider Engagement Manager to drive solutions related to provider claims, UM, setup, and payment issues. This a hybrid position with the expectation of 1-2 days per week in the office/community. We are looking for candidates in the Portland Metro area.

Requirements

Minimum 5 years relevant experience relating to physical and/or behavioral health with a minimum of 3 years direct experience in provider relations, managed care operations, medical clinic operations, or related healthcare organization
Minimum 3 years’ experience working with Medicaid and/or Medicare, either from a health plan perspective or as a provider serving Medicaid and/or Medicare members
Minimum 1 year experience facilitating cross functional meetings and projects
Valid driver’s license, acceptable driving record, and automobile liability coverage or access to an insured vehicle
Advanced understanding of provider development, education, and relations
Strong knowledge of Medicare, managed care, and the Oregon Health Plan
Strong knowledge of fee schedules and healthcare payment methodologies
Advanced understanding of medical and behavioral health clinical operations
Strong knowledge of medical and behavioral health terminology
Advanced computer application skills, including Microsoft 365 Office products (Word, Excel, Outlook, PowerPoint, etc.) and Microsoft and Google-based internet browsers and search functions
Advanced skills in critical analysis, quantitative reasoning, creative problem-solving, and decision-making skills, especially in an environment with diverse staff, providers, and provider groups
Advanced communication skills, including listening, verbal and written
Strong skills in report writing and recording meeting minutes
Skills in developing, revising, and monitoring policies and procedures
Advanced understanding of appropriate professional behavior, appropriate work ethic, and integrity
Ability to learn and apply continuous improvement concepts
Ability to interact and provide excellent customer service for a variety of internal and external customers with good judgment, personal initiative, and motivation, while performing assignments that may be confidential and sensitive in nature
Ability to lead in both a fully and semi-virtual environment
Ability to lead and communicate within a matrixed reporting structure
Ability to represent the organization in public and private meetings and other gatherings related to areas of specialty
Ability to conduct both virtual and in-person group training sessions and to make presentations as needed
Ability to work independently, organize, prioritize, and manage multiple projects with short timelines
Ability to educate and give concise information through formal and informal provider education venues
Ability to develop and maintain professional relationships with providers, provider staff and other parties
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
Ability to see, read, hear, speak clearly, sit, and perform repetitive finger and wrist movement for at least 6 hours/day
Ability to stand and walk for at least 1-3 hours/day
Ability to operate a motor vehicle

Nice To Haves

Minimum 1 year experience in a supervisory or lead position or completion of CareOregon’s Aspiring Leaders Program; lead roles preferably include regular assistance to a manager or supervisor in staff hiring, coaching, performance evaluation, and other supervisory tasks
Experience hiring, coaching, performance evaluation, and other supervisory tasks
Experience supervising staff in geographically diverse locations

Responsibilities

Collaborate with Provider Relations Manager and provider network participants to develop, implement, and maintain provider training and education programs, policies and procedures, provider resource materials, and knowledge management that meet organizational business goals.
Lead key compliance related workflows including provider terminations, appointment access monitoring, and provider onboarding
Act as a key partner in developing solutions for systemic issues that impact the provider network, and supports team in communicating solutions to providers
Facilitate large provider partner meetings including communicating about complex claims issues, advocating for solutions, and engaging in sensitive conversations
Collaborate with Provider Relations Manager, regional leadership, and provider network participants to identify opportunities, implement network improvements, and communication strategies across all CCO’s and lines of business
Act as key stakeholder and/or SME on network related initiatives to enhance network access, stability, and member access to care.
Support team in research and resolution for provider issues and concerns, especially those that are escalated from the team or other departments.
Work in partnership with Provider Relations and Contracting leadership to escalate and address contractual issues and concerns throughout CareOregon’s service area.
Actively participate in internal discussions regarding the evolving role of provider relations in supporting all lines of business.
Identify potential providers that may enhance the network and direct to the appropriate Provider Relations Specialist for recruitment.
Ensure that concerns and perspectives of provider network participants are represented at CareOregon and, in partnership with Contracting, Credentialing, and other lines of business leaders, recommend ways to improve patient access, network adequacy, and provider network stability.
Keep abreast of changes and advancements in the Provider Relations, Medicare, and Medicaid arenas.
Act as a resource for the Provider Relations Specialist team.
Coordinate, monitor, report on, and supervise the day-to-day operations and daily activities of the Provider Relations team.
Conduct monthly check-ins with Provider Relations staff as well as regional leadership to review, track, and collaborate on strategic priorities and Provider Relations annual goals.
Ensure the Provider Relations team effectively collaborates with other CareOregon teams, departments, and business partners.
Regularly attend recurring meetings as a representative of the Provider Relations team, and effectively disseminate relevant information, as needed.
Create and update documentation and resource materials for the Provider Relations team and other CareOregon departments, as needed.
Perform the functions of a Provider Relations Specialist, as needed.
Supervises team and recommends team direction and goals in alignment with the organizational mission, vision, and values.
Identifies work and staffing needs to meet work expectations; recruits and hires, using an equity, diversity, and inclusion lens.
Plans, organizes, schedules, and monitors work; ensures employees have information and resources to meet job expectations.
Leads the development, communication, and oversight of team and individual goals; ensures goals, expectations, and standards are clearly understood by staff.
Trains, supervises, motivates, and coaches employees; provides support toward employee development.
Incorporates guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, and decision making.
Ensures team adheres to department and organizational standards, policies, and procedures.
Evaluates employee performance and provides regular feedback to support success; recognizes strong performance and addresses performance gaps and accountability (corrective action).
Performs supervisory tasks in collaboration with Human Resources as needed.