Provider Relations Specialist II

Provider Relations Specialist II

---------------------------------------------------------------

Job Summary
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

Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.

---------------------------------------------------------------

Essential Responsibilities

Provider Development & Education

• 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.

Provider Relations

• 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.

Internal Liaison

• 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.

Contract Initiation

• 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.

Administration

• 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.

Organizational Responsibilities

• 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.

Experience and/or Education

Required

• 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

Knowledge, Skills and Abilities Required

Knowledge

• 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

Skills and Abilities

• 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

Working Conditions

Work Environment(s):        ☒ Indoor/Office    ☒ Community      ☐ Facilities/Security     ☒ Outdoor Exposure

Member/Patient Facing:    ☒ No                          ☐ Telephonic        ☐ In Person

Hazards:  May include, but not limited, to physical and ergonomic hazards.

Equipment:  General office equipment

Travel:  This position requires travel outside of the workplace at least weekly; the employee’s personal vehicle may be used. Driving infractions will be monitored in accordance wit

We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package.  Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.

We are an equal opportunity employer

CareOregon is an equal opportunity employer.  The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.