Provider Relations Specialist II - Behavioral Health

Career Opportunities: Provider Relations Specialist II - Behavioral Health (24539) Requisition ID 24539 - Posted 09/05/2024 - CareOregon - Full Time - Permanent - Portland - Multi Location (2) Job Description Print Preview Job Title Provider Relations Specialist II - Behavorial Health Exemption Status Exempt Department Provider Relations Manager Title Provider Relations Supervisor Direct Reports n/a Requisition 24539 Pay and Benefits Estimated hiring range $64,130 - $78,390 /year, 5% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits Posting Notes This is a hybrid role that will require you to go into office/community 1-2 days a week. Job Summary This position serves as a primary liaison between CareOregon and the provider-partner network, which includes contracted, non-contracted, and potential providers. This position focuses on establishing, building, and strengthening provider-partner relationships among contracted providers. Primary responsibilities include an intermediate level of provider onboarding, development, education, and relations. This position is a valuable liaison and collaborator with internal CareOregon teams and is essential in identifying network needs, gaps, resolutions, and ensuring contract and regulatory requirements are met. This position will assist with the contract development process, site visits, and general department administration. Work may be focused on physical, behavioral, and/or community-based healthcare networks. Essential Responsibilities Provider Development & Education Develop and maintain effective working relationships across the provider network. Develop and effectively communicate strong understanding of network eligibility and support, ensuring a high-quality provider network. Play key role in new provider contract determinations and oversight. Conduct new provider orientations (PCPs, Specialists, Vendors); train clinic office staff on CareOregon administrative processes. Conduct group training sessions and make presentations with minimal supervision. 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 within an identified area with focus on contracted providers to develop, address and monitor needs. Conduct provider site visits to maintain ongoing relations and effectiveness. Research provider questions and connect them to appropriate resources; ensure resolution to root cause of provider issues and concerns. Perform provider complaint resolution with contracted and non-contracted entities, including PCPs, specialists, hospitals, and vendors. 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, providing knowledgeable insights and contributions. Effectively facilitate large, complex provider meetings. Attend CareOregon events, serving as an integral team member. Work closely with other internal departments, including Claims, Credentialing, and Provider Data; address processes that affect providers and partner in the resolution of issues, including Peer Review. Participate in Clinical Advisory Panel (CAP) meetings. Contract Initiation Identify potential providers that may enhance the network.