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.

About the Role

This is a 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).

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.
• Address contractual issues and concerns in assigned areas; conduct complaint visits, as needed.
• 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.

Qualifications

• 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.

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.
• 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.

Pay

Estimated Hiring Range $66,690.00 - $81,510.00

Schedule

This position requires travel outside of the workplace at least weekly; the employee’s personal vehicle may be used.