Provider Relations Supervisor
CareOregon, Inc., Portland, OR, United States
Provider Relations Supervisor page is loaded## Provider Relations Supervisorremote type:
1-2 days per week in Officelocations:
Portland Oregontime type:
Full timeposted on:
Posted 2 Days Agojob requisition id:
JR100856Provider Relations Supervisor---------------------------------------------------------------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.**Estimated Hiring Range:**$90,225.00 - $110,275.00**Bonus Target:**Bonus - SIP Target, 5% AnnualCurrent CareOregon Employees: Please use the internal Workday site to submit an application for this job.---------------------------------------------------------------## **Essential 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.## ## Employee Supervision* 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.### **Experience and/or Education**Required* 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 vehiclePreferred* 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## Knowledge, Skills and Abilities RequiredKnowledge* 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 terminologySkills and Abilities* 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
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1-2 days per week in Officelocations:
Portland Oregontime type:
Full timeposted on:
Posted 2 Days Agojob requisition id:
JR100856Provider Relations Supervisor---------------------------------------------------------------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.**Estimated Hiring Range:**$90,225.00 - $110,275.00**Bonus Target:**Bonus - SIP Target, 5% AnnualCurrent CareOregon Employees: Please use the internal Workday site to submit an application for this job.---------------------------------------------------------------## **Essential 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.## ## Employee Supervision* 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.### **Experience and/or Education**Required* 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 vehiclePreferred* 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## Knowledge, Skills and Abilities RequiredKnowledge* 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 terminologySkills and Abilities* 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
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