If you receive an offer of employment for this position, it is contingent on the satisfactory completion of a pre-employment background check, immunization review, and drug screen (including THC/Marijuana). CareOregon is a federal contractor and must comply with all federal laws.

Job Title

Provider Relations Specialist I

Department

116 - Provider Relations

Exemption Status

Exempt

Requisition #

24280

Direct Reports

n/a

Manager Title

Provider Relations Supervisor

Pay & Benefits

Estimated hiring range $ 56,730 - $68,640 / year, 5% bonus target, full benefits.

www.careoregon.org/about-us/careers/benefits

Posting Notes

This is a hybrid position with an in office and community presence. Local to Medford or within a commutable distance.

Job Summary

This position serves as a primary liaison between CareOregon and the provider network, which includes contracted, non-contracted, and potential providers. This position focuses on establishing and supporting consistent and reliable provider network relationships. Primary responsibilities include triaging, monitoring, and coordinating provider requests, with a specific focus on non-contracted providers’ needs and supporting relationship development. This position is a valuable collaborator with internal CareOregon teams to identify network gaps, support resolutions, and adhere to contract and regulatory requirements. This position may also assist with the contract initiation process and general department administration. Work may be focused on physical, behavioral, and/or community-based healthcare services.

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

• Cultivate relationships with providers to enhance the provider experience, access to quality of care for members, and healthcare transformation.

• Engage the provider network with focus on non-contracted providers to address and monitor needs.

• Conduct provider site visits to maintain ongoing relations and effectiveness.

• Learn to research provider questions and connect them to appropriate resources; coordinate resolution of root cause of provider issues and concerns.

• Participate in 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 Data; help address processes that affect providers and partner in the resolution of issues.

• 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

• 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. 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

  Knowledge, Skills and Abilities Required

  Knowledge

• Knowledge of managed care and the Oregon Health Plan

• Familiarity with fee schedules and healthcare payment methodologies

• 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

• Proficient communication skills, including listening, verbal, and written

• Strong service orientation

• Growing ability to give concise information

• Ability to conduct trainings and presentations

• Ability to articulate policies, instructions, goals, and objectives

• 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 up to 8 hours/day

• Ability to lift and carry for 1-3 hours/day on occasion

• Ability to operate a motor vehicle

  Working Conditions

  Work Environment(s): ☒ 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.

  #LI-Hybrid

  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.

  We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.

  Visa sponsorship is not available at this time.