Managed Care Provider Relations Manager jobs in Oregon

Company Description: 

Umpqua Health stands at the forefront of community health as a leading Coordinated Care Organization (CCO) committed to transforming healthcare delivery. Our mission is to enhance the well-being and health of the communities we serve through innovative, integrated, and patient-centered care. As a CCO, we are dedicated to coordinating physical, mental, and dental health services, ensuring comprehensive care for our members. Our team comprises professionals who are passionate about making a difference in healthcare. We value diversity, inclusivity, and the unique perspectives of our team members, creating a collaborative and supportive work environment. This synergy is essential in our approach to delivering holistic and personalized care to our community.

At Umpqua Health, safety and well-being are paramount. We maintain a drug-free workplace policy to ensure a healthy and productive environment for our employees, patients, and the community at large. This policy includes drug screening for all potential hires and a strict no-drug policy across our organization.

Umpqua Health is actively seeking a visionary and dynamic Business and Provider Relations Manager to join our team and play a crucial role in our organizations success in the healthcare industry. The Business and Provider Relations Manager is responsible for the development, oversight, and execution of strategic plans related to the provider-network and strategic business relationships within the scope of the Engagement and Experience department. Specifically, this position is responsible for ensuring management of the provider-partner relationships. This includes oversight of the provider experience and performance, which provides optimized access to healthcare services for Umpqua Health members. This role oversees the Provider and Business relationship team, which is responsible for developing, maintaining, and supporting effective relations with the provider and business community to enhance satisfaction and experience. 

• Develop and revise policy and procedures related to Provider Relations, including recommending and implementing new methods to improve provider education and support.
• Collaborate with major provider networks within Umpqua Health’s (UH) service area to develop and support community-based delivery of health care services in conjunction with Lines of Business and Benefit leadership, Quality and Contracting and other UH teams.
• Responsible for monitoring regulatory requirements and contribute to timely submission of deliverables related to the provider network team, which includes routine review, reporting, and communication across network-facing departments.
• Monitor network adequacy in partnership with Provider Network Contracting to inform strategy and measurable goals to optimize the provider network and enhance member access to services, which includes regular and routine reporting for both Medicaid and other payer standards.
• Collaborate with Customer Care, Data Solutions, Decision Support, Communications, Behavioral Health, Quality, and other departments to support the accuracy of information available to members and providers in the Provider Directory and Manual.
• Oversee any other required regulatory reporting and auditing functions that relate to the provider network.
• Collaborate with Operations to support the management of member PCP attribute to ensure assignment processes are working as designed, and to update assignment algorithms to match organizational priorities and objectives.
• Responsible for oversight of prospective, newly contracted, and termed provider-partner procedures in coordination with Provider Network Contracting, and Benefit leaders.
• Responsible for tracking and trending needs and resolutions.
• Review network utilization and recommend changes that improve patient access and ensure network stability.
• Provide support to Customer Care and lines of business and benefits related to Language Access.
• In partnership with Provider Network Contracting, develop a strategy and measurable goals for enhanced access and utilization of network focused electronic and internet-based systems for operational improvements.
• Act as resource for Engagement facing teams.
• Responsible for maintaining communications and coordinating updates with other internal departments, specifically related to regulatory and contractual requirements for Provider Network and Business Engagement.
• Take lead on department projects that improve provider network access, stability, relationships with contracted providers and business stakeholders.
• Ensure that concerns and perspectives of the provider network are represented at UH and OHA.
• Develop and implement provider education, training, communication, and procedures to improve provider satisfaction and achieve business goals.
• Interpret and clarify UH provider policies and procedures for staff and provider education agendas.
• Collaborate with Customer Care and Provider Network Contracts on content, communication and resolution related to Provider Survey process.
• Collaborate with Provider Network Contracts, Customer Care, and other departments to manage the content and structure of information available to members and providers in the Provider Directory.
• Identify potential providers that may enhance network access and direct to the appropriate Provider Relations team for recruitment.
• Manage team and recommend team initiatives and goals in alignment with the organizational mission, vision, and values.
• Identify work and staffing needs to meet work expectations; recruit and hire, using an equity, diversity, and inclusion lens.
• Plan, organize, schedule, and monitor work; ensure employees have information and resources to meet job expectations.
• Lead the development, communication, and oversight of team and individual goals; ensure goals, expectations, and standards are clearly understood by staff.
• Train, supervise, motivate, and coach employees; provide support toward employee development.
• Incorporate guidance from UH equity tools into people leadership, planning, operations, evaluation, and decision making.
• Ensure team adheres to department and organizational standards, policies, and procedures.
• Evaluate employee performance and provide regular feedback to support success; recognize strong performance and address performance gaps and accountability (corrective action).
• Perform supervisory tasks in collaboration with Human Resources as needed.

• Educational Background: Bachelor’s degree in Business or related field.
• Professional Experience: Minimum 5 years’ of progressively responsible professional experience in customer service or provider engagement.
• Innovative and Strategic Thinking: A track record of successfully contributing to the alignment of business goals with overarching strategic plans, demonstrating a comprehensive understanding of industry trends, competitive landscapes, and key drivers that impact organizational success.
• Communication and Decision-Making Abilities: Excellent written, oral, presentation, interpersonal, and negotiation skills.
• Technological Proficiency: Proficient in Microsoft Office and ability to adapt to technological changes.

Umpqua Health is an equal-opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and business needs. Our dedication to fairness and equality extends to all aspects of employment, including hiring, training, promotion, and compensation, without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law.