If you receive an offer of employment for this position, it is contingent on the satisfactory completion of a pre-employment background check, immunization review, and drug screen (including THC/Marijuana). CareOregon is a federal contractor and must comply with all federal laws. Job Title Dental Provider Network Operations and Engagement Specialist, Senior Exemption Status Exempt Management Level n/a Direct Reports n/a Manager Title Director, Oral Health Clinical Services Department Dental Requisition 24734 Pay & Benefits Estimated hiring range $71,340 - $87,200 / year, 5% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits Posting Notes This is a Hybrid role that will require 1-2 days per week or month in the Community or our Downtown Portland office (or at least 9 times/year) Job Summary This position serves as a primary liaison between CareOregon Dental and the provider-partner network, which includes contracted, non-contracted, and potential providers. This position will act as a main resource for highly engaged, and often complex, contracted providers. This position is primarily responsible for provider lifecycle management, including an advanced 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, and resolutions. This position assists with ensuring contract and regulatory requirements are met, site visits completed, data reports are reviewed, and the contract development process is supported. Work is focused on the CareOregon Dental network. Essential Responsibilities Provider Development & Education + Develop and effectively communicate strong understanding of network eligibility and maintains effective working relationships across a high performing provider network. + Develop and effectively communicate expert understanding of network eligibility and available resources to ensure a high performing and engaged provider network. + Play a key role in new provider contract determinations and oversight of eligibility criteria. + Conduct new provider orientations (PDPs, Specialists, Vendors) and identify training opportunities for clinic office staff such as, but not limited to CareOregon administrative processes and regulatory requirements. + Autonomously develop and lead group training sessions and presentations. Provider Relations + Cultivate relationships with providers to enhance the provider experience, access to quality of care for members, and healthcare transformation. + Engage the CareOregon Dental provider network to develop, address, and monitor performance. + Conduct provider site visits to maintain ongoing effective and professional relationships. + Track, research, and resolve provider questions; ensure appropriate resources are offered and root cause of provider issues are appropriately documented and addressed. + Perform provider complaint resolution with contracted and non-contracted entities, including PDPs, specialists and vendors. + Address contractual issues and concerns; conduct complaint visits as needed. + Act as a key liaison to clinics to understand and use standard reporting, including capacity, financial, member assignments, and utilization. + Promote and advocate for provider engagement in learning collaboratives, network trainings, and other educational spaces. Internal Liaison + Participate on interdepartmental initiatives and teams, providing knowledgeable insights and contributions. + Effectively facilitate provider meetings. + Attend CareOregon events, serving as an integral team member. + Collaborate closely with other internal departments, including Claims, Credentialing, Provider Data, Provider Customer Service, Quality, and Innovations; address processes that affect dental providers and partner in the resolution of issues, including Peer Review. + Understand and advocate for the unique needs of the dental benefit and providers internally. Escalate when internal process across departments will adversely impact dental providers or processes. Contracting + Develop and evaluate proposed fee schedules for dental primary and specialty providers. Maintain provider fee schedules. + Identify and recruit potential providers that may enhance the network. + Obtain and review provider application data; submit to provider contracting staff. + Collaborate with Contracting team in facilitation of provider contract terminations. + Initiate and work with Contracting team to execute any required single case agreements. + Follow all organizational policies and procedures for provider contracting. Administration + Contribute to the development and oversight of relevant policies and procedures. + Actively participate in department meetings. + Advocate, consult, and inform on CareOregon program development and initiatives. + Mentor new team members, serving as a resource 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’ relevant experience relating to healthcare. Experience should include involvement in several of the following areas: Dental provider networks, provider relations, managed care operations (e.g., claims, appeals, grievances, customer service), dental health clinic operations, and/or related health care functions + Valid driver’s license, acceptable driving record, and automobile liability coverage or access to an insured vehicle Preferred + 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, provider directory, compliance, and customer service) Knowledge, Skills and Abilities Required Knowledge + Advanced understanding of managed care and the Oregon Health Plan + Strong knowledge of dental fee schedules and healthcare payment methodologies + Advanced understanding of provider network (primary and specialty dental) + Strong understanding of dental clinic operations Skills and Abilities + Proficient computer skills in Microsoft Office, including Word, Excel, and Outlook + Advanced communication skills, including listening, verbal, and written + Strong service orientation + Advanced skills in conducting trainings and presentations + Strong ability to clearly articulate policies, instructions, goals, and objectives + Strong ability to coach others and serve as an effective resource + Strong ability to develop and revise policies and procedures + Advanced ability to give concise information + Advanced ability to work independently and collaboratively + Advanced ability to organize, prioritize and manage multiple projects + Advanced ability to develop and maintain professional relationships with providers, provider staff and internal colleagues + Advanced ability to problem-solve in an environment with diverse providers and provider groups + Advanced ability to work in an environment with diverse individuals and groups + Advanced ability to learn, focus, understand, and evaluate information and determine appropriate actions + Advanced ability to accept direction and feedback, as well as tolerate and manage stress + Ability to see, read, hear, speak clearly, and perform repetitive finger and wrist movement for at least 6 hours/day + Ability to sit for up to 8 hours/day. + Ability to lift and carry 1-3 hours/day on occasion. + Ability to operate a motor vehicle Working Conditions Work Enviornment(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 Travel: This position requires travel outside of the workplace at least weekly; the employee’s personal vehicle may be used. Driving infractions will be monitored in accordance with organizational policy. Work Location: Work from home/ Hybrid #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. We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status. Visa sponsorship is not available at this time.