CareOregon Hiring For Provider Relations Specialist I at Portland, OR  Full Time

To protect the health and well-being of our members, employees and community, CareOregon requires all employees to be fully vaccinated against COVID-19 or have an approved medical or religious exception as a qualification of employment.

Candidates who receive an offer of employment by CareOregon, must provide proof of COVID-19 vaccination or submit a medical or religious exception request, which will be evaluated in accordance with CareOregon’s standard accommodation process.

Job Title	Provider Relations Specialist I
Exemption Status	Exempt
Department	Provider Relations
Manager Title	Provider Relations Supervisor
Direct Reports	n/a
Requisition #	23095

Job Summary

This position serves as a primary liaison between CareOregon and the provider network, which includes contracted, non-contracted, and potential providers. Primary responsibilities include provider development, education, and relations, as well as a valuable liaison and collaborator with internal CareOregon teams. This position also assists with the contract development process and general department administration. Work may be focused on physical health and/or behavioral health.

Essential Responsibilities

Provider Development & Education

• Develop and maintain effective working relationships across the provider network.
• Conduct new provider orientations (PCPs, Specialists, Vendors); train clinic office staff on CareOregon administrative processes.
• Grow skills in conducting group training sessions and make presentations as needed.

Provider Relations

• Work with provider network within an identified area to develop and support community-based delivery of health care services.
• Conduct PCP/OB site visits to maintain ongoing relations and effectiveness.
• Research provider questions and connect them to appropriate resources, coordinate resolution of root cause of provider issues and concerns.
• Perform provider complaint resolution with contracted and non-contracted entities, including PCPs, specialists, hospitals, and vendors.
• Help 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.
• Grow skills in facilitating provider meetings.
• Attend CareOregon events, serving as an integral team member.
• Work closely with other internal departments, including Claims, Credentialing, and Provider Configuration; help address processes that affect providers and partner in the resolution of issues.
• Participate in CAP meetings.

Contract Initiation

• Identify potential providers that may enhance the network.
• Obtain and review provider application data; submit to provider contracting staff.

Administration

• Grow knowledge of and contribute to relevant policies and procedures.
• Actively participate in department meetings.
• Provide information on CareOregon program development and initiatives.

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 2 years’ relevant experience relating to physical and/or behavioral health. Experience should include work in one or more of the following areas: Provider relations, managed care operations (e.g., appeals, grievances, customer service), medical 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

• Knowledge of managed care and the Oregon Health Plan
• Basic knowledge of Resource-Based Relative Value Scale (RBRVS)
• Familiarity with provider network (physical and/or behavioral health)
• Basic understanding of medical clinic operations

Skills and Abilities

• • Proficient computer skills in Microsoft Office, including Word, Excel, and Outlook
• Communication:
  • Proficient communication skills, including listening, verbal, and written
  • Strong service orientation
  • Ability to conduct trainings and presentations
  • Ability to articulate policies, instructions, goals, and objectives
  • Growing ability to give concise information
• Other:
  • Ability to work independently and collaboratively
  • Ability to organize, prioritize and manage workload and projects
  • Ability to provide input into policies and procedures
  • Ability to develop and maintain professional relationships with providers, provider staff and internal colleagues
  • 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 at least 3-6 hours/day
• Ability to operate a motor vehicle

Working Conditions

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 with organizational policy.

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment

Veterans are strongly encouraged to apply.

Equal opportunity employer. This company considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.