Lead Specialist in Provider Relations

2 weeks ago

Saint Helens, Oregon, United States CareOregon Full time

Career Opportunities:
Lead Specialist in Provider Relations - Behavioral Health
Department: Provider Relations
Exemption Status: Exempt
Direct Reports: n/a
Manager Title: Provider Relations Supervisor
Pay & Benefits: Estimated hiring range $70,310 - $85,075 / year, 5% bonus target, full benefits.

Position Overview:
This hybrid role involves both in-office and community engagement. The selected candidate will collaborate with the Behavioral Health Provider Relations Team and other internal teams focused on Behavioral Health, supporting the Behavioral Health Provider Network.

Key Responsibilities:
This position operates in a leadership capacity, assisting supervisors with essential unit functions and serving as a primary escalation and training resource for staff. The Lead Specialist acts as a vital liaison between CareOregon and the provider network, which encompasses contracted, non-contracted, and prospective providers. Additionally, this role involves assisting with contract development and general departmental administration, with a focus on physical health, behavioral health, and community-based provider support.

Provider Development & Education:
Establish and maintain effective working relationships within the provider network. Stay informed about changes and advancements in Provider Relations, Medicare, and Medicaid. Conduct new provider orientations and train clinic office staff on administrative processes. Facilitate group training sessions and presentations.

Provider Relations:
Engage with the provider network in designated areas, prioritizing high-need providers to enhance community-based healthcare delivery. Conduct site visits to maintain relationships and effectiveness. Address provider inquiries and ensure resolution of issues. Manage provider complaints and contractual concerns, cultivating relationships to improve provider experience and quality of care.

Internal Liaison:
Participate in interdepartmental initiatives, providing insights and disseminating relevant information. Facilitate complex provider meetings and collaborate with various internal departments to address processes affecting providers.

Contract Initiation:
Identify potential providers to enhance the network and assist in the application review process.

Administration:
Contribute to the development of policies and procedures, actively participate in departmental meetings, and mentor team members.

Employee Leadership:
Provide mentorship and leadership to support team goals, assist in staffing needs, and monitor employee performance.

Organizational Responsibilities:
Align work with the organization's mission and values, supporting equity, diversity, and inclusion initiatives.

Experience and Education:
Minimum of 5 years of relevant experience in physical and/or behavioral health, including provider relations and managed care operations. Valid driver's license and acceptable driving record required.

Knowledge, Skills, and Abilities:
Strong understanding of provider development, Medicare, managed care, and healthcare payment methodologies. Excellent communication skills and the ability to conduct training and presentations effectively.

Working Conditions:
Indoor/Office, Community, Facilities/Security, Outdoor Exposure. This position requires travel outside of the workplace at least weekly.

CareOregon is committed to building a diverse and inclusive work environment. We encourage candidates of color and veterans to apply. We are an equal opportunity employer.

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