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Job Title Operations Manager – Provider Network Exemption Status Exempt Department Provider Engagement Manager Title Director, Provider Engagement Direct Reports Provider Network Operations Team Requisition # 23831 Pay and Benefits Estimated hiring range $96,950 - $117,315 / year, 5% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits Posting Notes This role supports operations in the Portland Metro area as well as Jackson Care Connect and Columbia Pacific CCO networks. Occasional travel will be needed to Medford and Oregon's Northern Coastal region. Job Summary This position is responsible for leading and managing operations related to the provider-partner network within the scope of the Provider Engagement team. Specifically, this position is responsible for ensuring oversight and management of network adequacy, satisfaction, resource allocation, policies, procedures, and state and federal regulatory requirements. In partnership with the department leadership team, this position contributes toward the implementation oversight and support of leadership strategic development plans, process improvements, and intra and cross departmental operational systems that impact the department and provider-partner network. Additionally, this position partners with provider and network engaged teams. Essential Responsibilities Operations
Develop, implement, and review provider-partner network related policies, procedures, and monitoring systems for day-to-day execution of provider network-related operations, resources, deliverables, policies, and procedures of network operations.
Identify potential gaps and/or barriers to policies and procedures and take steps to mitigate or establish them.
Facilitate, manage and/or collaborate with other departments and teams to coordinate network-related systems and processes; identify and define current and future resource needs within a heavily matrixed environment.
Analyze, recommend, implement, and train network-related operations, processes, policies, and procedures internally and externally.
In partnership with department leadership, manage communications related to work being done, resources and training available, and opportunities for collaboration.
Collaborate with network-involved teams to identify process/system areas to improve network operations and policies.
Collaborate with leadership to identify and develop standards for monitoring network adequacy and network-related reporting and dashboards.
Collaborate with data analysts and the quality improvement teams to identify, develop, and present relevant network-related data.
In partnership with Regulatory Affairs and Compliance teams, provide oversight and management of regulatory requirement deliverables related to network adequacy, access, and performance.
Develop and maintain customer and vendor relationships with internal and external stakeholders to aid in operations delivery.
Provide leadership and act as an information resource to the organization; lead operations problem-solving.
Serve as a liaison for internal and external partners as it relates to network priorities and needs.
Facilitate, manage, and/or participate in centralized network-related committee(s).
Collaborate with leadership and network-involved teams to facilitate and manage the coordination of network-related communications and current/future processes using change management techniques.
Program and Project Supports
Support programmatic needs of network-related priority projects and programs Provider Engagement is accountable for.
Monitor resource allocation of staff, training tools, and technical systems required to effectively achieve timely and high-quality outcomes.
Oversee and manage network project involving change management.
Network Panel Oversight
Oversee provider intake/exit process to ensure a positive provider experience.
Support provider engagement strategies and communications across the organization.
Monitor and oversee network related trainings, resource materials, communications, and outreach initiatives.
In partnership with other network-facing teams, monitor and support process improvements related to management of provider information, including but not limited to provider information forms, provider directory, provider profiles and system configuration, provider onboarding, provider capacity, provider performance, and provider experience.
Administration & Planning
Partner with Provider Relations management team on provider network operations.
Develop and operationalize tracking and reporting structures related to training, policies, procedures, and priority projects.
Manage organizational change in a way that includes staff participation and engagement at all levels of the organization.
Organize and oversee activities related to workgroups, collaborations, committees, trainings, retreats, team development, and other forums to ensure collaboration and cohesion.
Organize and manage annual operational activities, including budget development, employee performance, and retreats.
In partnership with department leaders and network-facing teams, co-develop and manage a network portfolio including priority projects and affiliated performance dashboards.
Financial Monitoring
Manage training budget and payment/reimbursement process for staff and network-related initiatives.
Coordinate with Finance and Contracting to manage and monitor network-related cost and utilization trends.
Participate and support network strategic planning.
Coordinate with internal teams to manage and support network-related financial dashboards.
Employee Supervision
Manage team and recommend team direction and goals in alignment with 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 CareOregon 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 provides regular feedback to support success; recognize strong performance and addresses performance gaps and accountability (corrective action).
Perform supervisory tasks in collaboration with Human Resources as needed.
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 5 years’ of progressively responsible professional experience related to clinic-network operations or healthcare management, including 2 years’ experience leading large, complex enterprise-wide projects and experience in facilitating large multi-stakeholder collaborations
Preferred
Minimum 2 years’ experience in a supervisory position or minimum 1 year experience in a supervisory position with completion of CareOregon’s Aspiring Leaders Program
Experience working in a healthcare system, clinical delivery system, or managed care organizations (Medicaid and/or Medicare)
Broad experience with a corporate matrix environment, with regular interface with centralized and field-based operational and business development functions (finance, network, contracting, medical management, sales, and customer service)
Knowledge, Skills and Abilities Required
Knowledge
Understanding of provider development, education, and relations
Knowledge and understanding of Medicare, managed care, and the Oregon Health Plan
Understanding of provider network support (physical health, behavioral health, and/or community-based)
Strong understanding of health system operations
Understanding of healthcare policy, clinical quality of care measures, case and disease management, and network management
Strong knowledge of information systems used in health systems to support clinical care and quality improvement initiatives
Knowledge of Medicaid and Medicare regulatory and contractual requirements
Strong understanding of techniques used in change management
Knowledge of healthcare terminology
Skills and Abilities
Strong computer application skills, including with Microsoft 365 Office products (Word, Excel, Outlook, PowerPoint, etc.), and Microsoft and Google-based internet browsers and search functions
Excellent communication skills, including listening, verbal, and written
Strong project management skills with the ability to plan, develop, prioritize, manage, and implement tasks, activities, and processes to achieve goals within established timelines
Skilled at conducting trainings, meetings, and presentations, both virtual and in-person
Skilled in driving results, thinking strategically, and executing strategy effectively; thinking at an enterprise level
Ability to create and manage visual displays or maps of processes, timelines, and/or projects.
Results-oriented with a high attention to detail, ability to multi-task, and meet deadlines in a demanding, fast-paced environment
Ability to coordinate and facilitate a strategic planning process and visible ongoing monitoring system.
Ability to advise on trend analysis and causes of variances
Strong ability to utilize and reference internal and external resources
Strong ability to develop and maintain professional relationships with providers, provider staff and internal colleagues
Ability to clearly articulate policies, instructions, goals, and objectives
Ability to work independently and collaboratively with minimal supervision
Ability to work effectively 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, and perform repetitive finger and wrist movement for at least 6 hours/day
Ability to hear and speak clearly for at least 3-6 hours/day
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 and/or mobile technology
Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used.
#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.
Equal opportunity employer. This company considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.
