Provider Data Management Specialist Jobs (NOW HIRING)

Director, Provider Data Management-This position is responsible for enterprise leadership and strategic oversight of CareOregon’s provider network data management, including provider data management and credentialing. Primary duties include strategic and operational leadership and planning, as well as resource, relationship, and people management. The Director ensures cohesive operations support, timely and accurate provider data configuration, credentialing oversight, and overall operational excellence across Medicaid and Medicare lines of business. This position is also accountable for ensuring all plan operations are compliant with OHA, CMS, and NCQA standards as applicable.This position is required to be in the downtown Portland office 3x/week, We are looking for candidates in the Portland Metro area.Estimated Hiring Range:$155,430.00 - $189,970.00Bonus Target:Bonus - SIP Target, 10% AnnualCurrent CareOregon Employees: Please use the internal Workday site to submit an application for this job.-Essential ResponsibilitiesTechnical/Operational LeadershipProvide strategic leadership for provider data management, including credentialing, and provider data.Develop and oversee execution of proactive strategic initiatives to ensure appropriate network development and wholistic provider data management.Ensure network practitioners are credentialed per plan policies.Ensure provider data systems are optimized to enable strategic network management, including accurate and timely claims processing and directory presentation.Effectively use business intelligence and data analytics to monitor network data accuracy, forecast system changes and overall plan data needs.Ensure compliance with federal, state, and contractual requirements.Identify and implement process improvement activities to improve department productivity.Ensure documented policies and procedures are established and maintained to ensure accurate, efficient, and compliant operations.Remain current with healthcare industry trends, best practices, and approaches to drive efficient and compliant network operations.Financial/Resource ManagementDevelop budgets in alignment with strategic planning.Ensure teams have sufficient resources to perform their work.Ensure budgets are monitored and managed effectively across areas of oversight.Approve resource allocations within budget, including people, finances, and timelines.Relationship ManagementEnsure strategic messages are regularly and effectively relayed to management team and staff; promote transparency.Collaborate with leaders across the organization in identifying integrated improvement strategies and ensuring meaningful integration.Employee SupervisionDirect team(s) and establish team direction and goals in alignment with the organizational mission, vision, and values.Identify work and staffing models; recruit, hire, and oversee a team to meet work needs, using an equity, diversity, and inclusion lens.Identify department priorities; 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.Manage, coach, motivate, and guide employees; promote employee development.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.Organizational ResponsibilitiesPerform 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.Organizational ResponsibilitiesPerform 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 EducationRequiredMinimum 10 years’ experience in health plan operations, provider network engagement and/or hospital or medical staff credentialing.PreferredMinimum 4 years’ supervisory experienceManagement experience in a managed care organization or provider practice settingProvider relations experienceKnowledge, Skills and Abilities RequiredKnowledgeStrong understanding of Medicaid in a managed care environmentUnderstanding of claims, provider directories and provider dataUnderstanding of how to manage a production-oriented workforceUnderstanding of credentialing policies & practicesUnderstanding of network regulatory reporting, including DSN and HSD tablesKnowledge of federal Medicare regulations and state Medicaid rules (OARs)Skills and AbilitiesSkilled in strategic thinking and executing strategy effectively; ability to think at an enterprise levelLeadership effectiveness and ability to design and implement constructive changeStrong people management skills, including the ability to coach and motivate teamsExcellent critical thinking, analytical and problem-solving skills; ability to effectively analyze program goals and objectives to determine successes and opportunities for improvementAbility to effectively analyze program goals and objectives to determine successes and opportunities for improvementAbility to effectively convey business unit goals and plans ensuring integration into strategic plans and initiativesHighly skilled in resource managementAbility to communicate effectively, both verbally and in writing, including strong presentation and change management skillsAbility to influence and build consensusAbility to work in an environment with matrix reporting, diverse individuals and groupsAbility to work effectively with diverse individuals and groupsAbility to learn, focus, understand, and evaluate information and determine appropriate actionsAbility to accept direction and feedback, as well as tolerate and manage stressWorking ConditionsWork Environment(s): Indoor/Office Community Facilities/Security Outdoor ExposureMember/Patient Facing: No Telephonic In PersonHazards: May include, but not limited to, physical and ergonomic hazards.Equipment: General office equipmentTravel: 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.Work Location: Office - 3 days/weekWe offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.We are an equal opportunity employerCareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization. #J-18808-Ljbffr