Director, Provider Engagement
Position Title: Director, Provider Engagement
Department: Contract Management
Title of Manager: Vice President, Value Based Contracting
Supervises: Provider Relations Team
Exemption Status: Exempt
Requisition ID: 20890
This position is responsible for leading the execution of provider engagement strategy in collaboration with all Lines of Business (LOBs) to support network partners and activity across the organization. Time is focused on business group oversight, with secondary time on enterprise-wide engagement. Primary duties include technical and operational planning and oversight, as well as resource, relationship, and people management. This position provides input into strategic plans in provider engagement for the broader organization.
Education and/or Experience
Minimum 10 years’ experience in health plan operations and/or provider network engagement
Minimum 4 years’ supervisory experience
Management experience in a managed care organization or provider practice setting
Provider relations experience
Leads the execution of provider engagement strategic initiatives, plans, and goals for areas of oversight in collaboration with internal teams and alignment with organizational vision and goals.
Develops, operationalizes, and maintains effective network communication models to support network engagement with health plan functions in partnership with internal and external teams.
Works with internal leaders in the development, implementation, and maintenance of network models within regional networks.
Advises leadership on ways to improve CareOregon’s strategic positioning to support its current and future provider network and strategic partners.
Collaborates on process to evaluate network impact and continually review and adjust strategies accordingly.
Assists in the development of network evaluation plans as necessary.
Develops or ensures internal systems and measures are in place to support effective, efficient, and compliant network interface with health plan operations.
Ensures all applicable Medicaid/Medicare regulations are understood and operationalized.
Partners with internal teams to ensure CareOregon network regulatory reporting obligations are met in a timely and accurate manner for Medicaid/OHA and Medicare/COA LOBs (e.g., Delivery System Network (DSN) oversight and Network adequacy strategy and oversight).
Partners with Customer Experience, Information Services (IS), Marketing, and other departments to ensure network facing tools and supports are optimized and the network is engaged and knowledgeable of CareOregon processes and requirements (e.g., Provider Directory, Provider Survey, Provider Portal and other tools).
Collaborate with internal teams to manage member PCP assignment to ensure assignment processes and assignment algorithms are updated to match organizational priorities and objectives.
Oversees development and implementation of training, curriculum, collaboratives and materials to provide general support to our network partners across multiple LOBs to optimize network engagement via direct clinic interaction and/or newsletters, regular email updates.
Leads innovation, process review, and improvement efforts related to Provider Relations.
Provides oversight of the development and maintenance of policies, procedures, structures and training to support the staff and department into the future.
Leads and supports implementation of strategies to promote equity across internal and external department activities.
May serve as a sponsor or chair for key projects and initiatives.
Leads the oversight of network strategies in partnership with Quality and Innovation Support that supports delivery system transformation.
Develops, operationalizes, and maintains a Network Risk Strategy that supports the Network, Members and CareOregon’s needs and capitalizes on the existing work, regional and national initiatives.
Develops and leads provider and network engagement and communication strategies that support the work necessary to be successful in regional and national initiatives (e.g., CCO 2.0, CMS)
Participates in the development of vision, goals, and strategic plans across business teams and regions.
Provides input into strategic plans of the organization.
Maintains a business unit and member view while establishing department priorities, being cognizant of broader business unit and organizational impacts.
Recommends budgets in alignment with short- and long-term plans.
Manages resources to ensure priorities are accomplished.
Approves resource allocations within budget, including people, finances, and timelines; make decisions on exceptions.
Leads effective communication system for work group(s), ensuring a collaborative culture.
Builds and ensures effective relationships across internal teams and external organizations.
Partners with internal leaders and managers in identifying improvement plans and processes.
Represents CareOregon within and outside the organization, providing productive leadership presence and effectiveness.
Works closely with the internal leaders to ensure that agreements, relationships, reporting and programs are properly supported for our members and our network partners.
Cultivates strong business relationships with the provider community.
Provides strategic partnership and support to LOBs to implement and maintain operational initiatives that assure that CareOregon meets all provider regulatory deliverables.
Directs team(s) and establishes team direction and goals in alignment with the organizational mission, vision, and values.
Identifies work and staffing models; recruits, hires, and oversees a team to meet work needs, using an equity, diversity, and inclusion lens.
Identifies department priorities; 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.
Manages, coaches, motivates, and guides employees; promotes employee development.
Incorporates guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, budgeting, resource allocation, 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.
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 the organization’s strategic goals.
Adhere to the organization’s policies, procedures and other relevant compliance needs.
Perform other duties as needed.
Knowledge, Skills and Abilities Required
Extensive knowledge of managed care and the Oregon Health Plan
Demonstrated depth of experience in building relationships with multiple entities, including providers and community stakeholders
Knowledge of federal Medicare regulations and state Medicaid rules (OARs)
Knowledge of claims administration
Knowledge of physician group, hospital, and facility operations
Thorough knowledge of principles and statistical methodologies for program assessment and evaluation
Skilled in strategic thinking and executing strategy effectively; ability to think at an enterprise level
Leadership effectiveness and ability to design and implement constructive change
Strong people management skills, including the ability to coach and motivate teams
Ability to establish and maintain complex contractual relationships to align with specific corporate initiatives, strategies, goals and objectives.
Excellent critical thinking, analytical and problem-solving skills; ability to effectively analyze program goals and objectives to determine successes and opportunities for improvement
Ability to effectively analyze program goals and objectives to determine successes and opportunities for improvement
Ability to effectively convey business unit goals and plans ensuring integration into strategic plans and initiatives
Highly skilled in resource management
Ability to communicate effectively, both verbally and in writing, including strong presentation and change management skills
Ability to influence and build consensus
Ability to work in an environment with matrix reporting, diverse individuals and groups
Physical Skills and Abilities Required
Lifting/Carrying up to 10 Pounds
Pushing/Pulling up to 0 Pounds
Pinching/Retrieving Small Objects
More than 6 hours/day
More than 6 hours/day
More than 6 hours/day
Cognitive and Other Skills and Abilities
Ability to focus on and comprehend information, learn new skills and abilities, assess a situation and seek or determine appropriate resolution, accept managerial direction and feedback, and tolerate and manage stress.
Environment: This position’s primary responsibilities typically take place in the following environment(s) (check all that apply on a regular basis):
☒ Inside/office ☐ Clinics/health facilities ☐ Member homes
Travel: This position may include occasional required or optional travel outside of the workplace, in which the employee’s personal vehicle, local transit, or other means of transportation may be used.
Equipment: General office equipment
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.