Planning and Operations Specialist, Senior - Provider Network

Estimated Hiring Range: $92,070.00 - $112,530.00 with a 5% annual target bonus (SIP).

About the Role

This position leads, facilitates, and monitors planning and operations within the provider network team at a senior level. Responsibilities include guiding the strategic deployment and operational implementation of the provider network team's strategic plan, projects, and initiatives. The role ensures oversight of network adequacy, satisfaction, and compliance with state and federal regulatory requirements. In partnership with department leadership, this position contributes to executing strategic plans within the department and provider-partner network.

Responsibilities

Projects & Planning

• Monitor and guide the department-wide portfolio of projects and performance dashboard with minimal guidance from department leadership; guide department leaders and cross-functional teams in identifying priorities and advancing projects.
• Participate in developing, implementing, and monitoring clinical and/or operational strategy aligned with the organization and each line of business, region, or department.
• Identify and lead the process for developing and administering the team’s annual strategic plan, including underlying goals, projects, strategies, and metrics; influence and negotiate for necessary resources and timelines.
• Develop, collaborate, and implement a monitoring system with visibility to metrics, reporting, and progress toward goals.
• Liaise with other departments regarding costs, planning, and/or deliverables involving complex integration.
• Perform advanced project management for provider network initiatives.
• Lead and ensure internal and external stakeholder engagement to move strategies forward.
• Leverage multiple resources to ensure standard and specialized tools and processes are developed, deployed, and regularly improved to support projects and programs.
• Implement communications related to the provider network in partnership with department leadership.
• Collaborate with network-involved teams to identify process/system areas of improvement.
• Implement standards for monitoring network adequacy and network-related reporting and dashboards.
• Collaborate with data analysts and quality improvement teams on relevant network-related data.

Operations

• Inform, develop, and lead the operational infrastructure to ensure Provider Engagement and the provider network operates efficiently and delivers high-quality services.
• Educate and ensure staff understand the overall clinical and/or operational strategy and their role in supporting this work.
• Lead the team in working effectively across departments, regions, and lines of business within a matrix structure.
• Build, deploy, and lead communication systems and effective communication forums to guide cross-functional relationships.
• Develop and lead the Provider Engagement and provider network operations’ meeting infrastructure, including content, tracking, and reporting on deliverables.
• Staff senior leadership meetings and external meetings at the executive and operational level; attend and participate in meetings on behalf of business unit leaders.
• In partnership with department leadership and other senior leadership, identify content and presentations for enterprise-wide meetings.
• Organize and manage activities such as retreats, team development, and other forums to ensure collaboration and cohesion.
• Inform data analysts of core data needs; collaborate to extract and present relevant data internally and externally.
• Identify, implement, and train on departmental improvements for operational policies, procedures, and documentation.

Requirements

• Minimum 5 years’ experience in planning, operations, project, or program administration, including 2 years’ experience leading large, complex, and diverse multi-stakeholder collaborations within provider network operations.
• Experience as an influential communicator and creative problem solver across teams and within a complex organizational structure.
• Education or training in LEAN or related process improvement techniques.

Preferred Qualifications

• Program, project, or operations administration experience in a healthcare system, clinical delivery system, or managed care organizations (Medicaid and/or Medicare).

Skills

Required Knowledge

• Advanced understanding of principles, methods, and techniques of project management.
• Strong understanding of quality assessment measures.
• Strong understanding of Oregon Medicaid or Medicare in area of focus.
• Strong understanding of techniques used in change management.
• Knowledge of healthcare terminology.
• Strong understanding of health system operations.
• Strong knowledge of information systems used in health systems to support clinical care and quality improvement initiatives.
• Knowledge of health plan financing, healthcare costs, health outcome measures, and health plan operations.
• Strong knowledge of Medicaid and Medicare regulatory and contractual requirements.
• Understanding of provider development, education, and relations.

Required Skills and Abilities

• Strong computer application skills, including Microsoft 365 Office products (Word, Excel, Outlook, PowerPoint) and Microsoft/Google-based internet browsers and search functions.
• Excellent verbal and written communication and presentation skills, including the ability to articulate concepts to staff, partners, and stakeholders.
• Strong facilitation and stakeholder engagement skills.
• Skilled at conducting trainings, meetings, and presentations, both virtual and in-person.
• Excellent organizational skills; ability to apply process improvement techniques to department operations and create efficiencies.
• Proficiency in developing and facilitating strategic planning processes and a visible ongoing monitoring system for a variety of initiatives.
• Results-oriented with a high attention to detail, ability to multi-task, and meet deadlines in a demanding, fast-paced environment.
• Strong ability to develop, recommend, and implement policies, procedures, and guidelines.
• Ability to synthesize large volumes of information and data points into deliverables.
• Excellent ability to develop formal project/program plans and prioritize, manage, and implement tasks, activities, and processes to achieve goals within established timelines.
• Ability to create and manage visual displays or maps of processes, timelines, or projects.
• Ability to lead, motivate, and guide peers, cross-functional partners, and cross-department/network management toward goal attainment.
• Ability to develop and maintain strong professional working relationships with internal staff and departments and external stakeholders.
• Ability to effectively solve unique problems as they arise or identify when to direct issues to the appropriate department/supervisor.
• Ability to accept direction and feedback, as well as tolerate and manage stress.
• Ability to see, read, and perform repetitive finger and wrist movements for at least 6 hours/day.
• Ability to hear and speak clearly for at least 3-6 hours/day.

Working Conditions

• Work Environment(s): Primarily indoor/office setting.
• Member/Patient Facing: No direct in-person or telephonic interaction.
• Hazards: May include physical and ergonomic hazards.
• Equipment: General office equipment and/or mobile technology.
• Travel: Occasional required or optional travel outside of the workplace; personal vehicle, local transit, or other means of transportation may be used.
• Work Location: Hybrid-Office, 2 days/week.

Benefits

We offer a strong Total Rewards Program, including competitive pay, bonus opportunities, and a comprehensive benefits package. Eligibility for bonuses and benefits depends on position type and scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date.

• Insurance: Medical, dental, vision, life, AD&D, and disability insurance.
• Accounts: Health savings account, flexible spending account(s), lifestyle spending account.
• Wellness & Support: 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).
• Retirement: Strong retirement plan with employer contributions.
• Time Off: PTO and Paid State Sick Time accrual based on hours worked/scheduled hours and primary work state. 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.