Director, Provider Data Management

About the role

This position is responsible for enterprise leadership and strategic oversight of CareOregon’s provider network data management, including provider data management and credentialing. Primary duties include strategic and operational leadership and planning, as well as resource, relationship, and people management.

Responsibilities

• Provide strategic leadership for provider data management, including credentialing, and provider data.
• Develop and oversee execution of proactive strategic initiatives to ensure appropriate network development and wholistic provider data management.
• Ensure network practitioners are credentialed per plan policies.
• Afford provider data systems are optimized to enable strategic network management, including accurate and timely claims processing and directory presentation.
• Effectively use business intelligence and data analytics to monitor network data accuracy, forecast system changes and overall plan data needs.
• Afford compliance with federal, state, and contractual requirements.
• Identify and implement process improvement activities to improve department productivity.
• Ensure documented policies and procedures are established and maintained to ensure accurate, efficient, and compliant operations.
• Remain current with healthcare industry trends, best practices, and approaches to drive efficient and compliant network operations.

Requirements

• Minimum 10 years’ experience in health plan operations, provider network engagement and/or hospital or medical staff credentialing.
• Minimum 4 years’ supervisory experience.
• Management experience in a managed care organization or provider practice setting.
• Provider relations experience.

Qualifications

• Strong understanding of Medicaid in a managed care environment.
• Understanding of claims, provider directories and provider data.
• Understanding of how to manage a production-oriented workforce.
• Understanding of credentialing policies & practices.
• Knowledge of federal Medicare regulations and state Medicaid rules (OARs).

Skills and Abilities

• Strategic thinking and executing strategy effectively; ability to think at an enterprise level.
• Leadership effectiveness and ability to design and implement constructive change.
• People management skills, including the ability to coach and motivate teams.
• Excellent critical thinking, analytical and problem-solving skills; ability to effectively analyze program goals and objectives to determine successes and opportunities for improvement.
• Highly skilled in resource management.
• Effective communication skills, both verbally and in writing, including strong presentation and change management skills.
• Influence and build consensus.
• Work in an environment with matrix reporting, diverse individuals and groups.
• Learn, focus, understand, and evaluate information and determine appropriate actions.
• Accept direction and feedback, as well as tolerate and manage stress.

Benefits

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.

Working Conditions

• Work Environment(s): Indoor/Office
• Member/Patient Facing: No
• Hazards: May include, but not limited to, physical and ergonomic hazards.
• Equipment: General office equipment
• Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used.
• Work Location: Office - 3 days/week

Pay

Estimated Hiring Range $155,430.00 - $189,970.00 Bonus Target Bonus - SIP Target, 10% Annual

Schedule

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