Allcare Health Jobs (NOW HIRING)

AllCare Health offers competitive wages, an excellent benefits package including affordable healthcare, 401k retirement, wellness programs, and flexible schedule options.

The Oral Health Specialist is responsible for supporting the administration, coordination, and oversight of oral health programs and benefits for Coordinated Care Organization (CCO) members in compliance with Oregon Health Plan (OHP) contractual requirements and applicable regulatory standards.

This position serves as a primary resource for oral health operations, collaborating with Dental Care Organizations (DCOs), providers, internal departments, and community partners to support program implementation, provider engagement, compliance monitoring, policy development, and quality improvement initiatives.

The Oral Health Specialist works closely with BMPS Leadership, Compliance Leadership, Medical Directors, Population Health Leadership, and interdisciplinary teams to improve access to high-quality oral health services and advance equitable health outcomes.

Essential Duties

1. Oral Health Program Compliance and Integration: Support compliance with OHP requirements and program integrity for AllCare Health and its oral health subcontractors. Assist in monitoring program activities to ensure alignment with state regulations.
2. Policy Development and Maintenance: Collaborate with internal and external stakeholders to assist in developing and maintaining policies that improve access, quality, and affordability of oral health services while ensuring they remain current and compliant with contractual requirements.
3. Provider Engagement and Support: Act as a key resource for oral health operations, serving as a liaison with oral health subcontractors. Foster effective communication, support provider engagement, and assist in ensuring compliance with state requirements.

Job Duties

• Act as a key resource for oral health operations, with a focus on compliance, benefit management, and provider relations.
• Serve as the primary liaison between oral health subcontractors and AllCare Health, fostering effective communication and collaboration.
• Support AllCare Health and its oral health subcontractors in maintaining compliance with contractual requirements, Oregon Administrative Rules (OARs), and Code of Federal Regulations (CFRs) for oral health benefits by leading regular monthly check- in meetings with each DCO. Also attending monthly AllCare subcontractor meetings to present any findings or concerns.
• Assist in maintaining and updating oral health policies to ensure they remain relevant, accurate, and aligned with regulatory requirements.
• Provide operational support to the Medical Director for Oral Health and the Medical Director of Orthodontics, ensuring seamless program implementation.
• Represent AllCare Health in local, state, and regional oral health meetings and committees as directed by organizational leadership.
• Support the development of new access points for oral health services to improve care delivery for AllCare members.
• Monitor oral health provider contracts to ensure compliance with quality standards and oversee implementation of alternative payment models (APMs) for Dental Care Organizations (DCOs) and individual providers.
• Assists provider engagement team with the development of language and requirements for contracts and provider education.
• Assists grievance team when needed to investigate and document complaints related to oral health services, ensuring appropriate follow-up and resolution.
• Coordinate internal and external teams on population health initiatives, including care coordination for oral health issues as delegated.
• Provide excellent customer service by addressing provider and/or DCO concerns in a timely and effective manner.
• Maintains punctual, regular and predictable attendance.
• Works collaboratively in a team environment with a spirit of cooperation.
• Respectfully takes direction from leadership.
• Meets all required training including those listed in Relias Learning Module System (LMS).
• Performs other duties as assigned.

On Call Responsibilities

This position does not have any on call responsibilities.

Supervisory Responsibilities

This position does not have any supervisory responsibilities.

Job Requirements

• May require the use of personal vehicle for local travel (subject to mileage reimbursement).
• May require the use of a personal cell phone (cell phone stipend applicable).

Qualifications

Ability to perform essential job duties with or without reasonable accommodation and without posing a direct threat to safety or health of employee or others. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

Being bilingual in another language, including American Sign Language (ASL), is an invaluable skill that enhances our ability to deliver culturally responsive care. We strongly encourage you to apply if you are bilingual.

All relevant experience can be listed in your resume to perform essential duties of the position including the following:

Education

Bachelor's degree in Healthcare Administration, Public Health, Business Administration, Dental Hygiene, Health Sciences, or a related field; or an equivalent combination of education and relevant experience.

Experience

• Two (2) years of experience in healthcare, managed care, oral health, Medicaid, or health insurance.
• One (1) year of experience working with Oregon Health Plan (OHP), Medicaid, Dental Care Organizations (DCOs), provider relations, compliance, or healthcare operations.
• Experience interpreting policies, regulations, contracts, or administrative rules preferred.
• Experience coordinating cross-functional projects, provider engagement activities, or quality improvement initiatives preferred.
• Experience working with healthcare data, reporting, or performance metrics preferred.

Certificates, Licenses, and/or Registrations

• Valid Oregon Driver's License and vehicle insurance.

Technical Skills

• Knowledge of the healthcare industry, including managed care, Medicaid, and Oregon Health Plan (OHP) programs preferred.
• Knowledge of healthcare regulations and compliance requirements, including HIPAA, Oregon Administrative Rules (OARs), and applicable Code of Federal Regulations (CFRs).
• Excellent written and verbal communication skills, including writing, editing, proofreading, and preparing professional correspondence and reports.
• Excellent organizational, time management, and project coordination skills with the ability to manage multiple priorities and meet deadlines.
• Proficient in Microsoft Office Suite (Outlook, Word, Excel, and PowerPoint) and other business software applications.
• Ability to interpret policies, contracts, regulations, and technical guidance and apply them appropriately.
• Ability to identify process improvement opportunities and implement effective solutions.
• Strong analytical and critical thinking skills with the ability to interpret data, identify trends, and make recommendations.
• Ability to research, evaluate, and synthesize information from multiple sources.
• Knowledge of customer service and service recovery best practices.
• Ability to develop and deliver training, educational materials, and provider communications.
• Knowledge of provider relations and healthcare network operations preferred.
• Knowledge of the ways implicit bias, personal identity, power, and privilege impact individuals, organizations, and systems.

Interpersonal Skills

• Demonstrate accountability and build trust with colleagues, providers, subcontractors, and other stakeholders.
• Build and maintain collaborative working relationships with internal and external partners.
• Demonstrate initiative and work effectively in a fast-paced environment with minimal supervision.
• Communicate professionally and effectively with diverse audiences, including providers, leadership, members, and community partners.
• Collaborate effectively within multidisciplinary teams to achieve organizational goals.
• Provide exceptional customer service while responding to questions, concerns, and issues in a timely and professional manner.
• Prioritize and organize work to meet competing deadlines and changing business needs.
• Adapt quickly to change, learn new processes, and work effectively in ambiguous situations.
• Exercise sound judgment, critical thinking, and problem-solving skills when making decisions.
• Facilitate productive meetings, discussions, and cross-functional collaboration.
• Maintain professionalism, confidentiality, and discretion when handling sensitive information.
• Demonstrate empathy, cultural humility, and respect when interacting with individuals from diverse backgrounds.
• Influence and collaborate with others without direct supervisory authority.
• Demonstrate self-awareness and adapt behaviors based on feedback and changing circumstances.
• Negotiate effectively, consider diverse perspectives, and resolve conflicts constructively.
• Commit to fostering