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 - $189,970.00

Bonus Target:
Bonus - SIP Target, 10% Annual

Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.

Essential Responsibilities
Technical/Operational Leadership

• Provide 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 Management

• Develop 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 Management

• Ensure 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 Supervision

• Direct 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 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.

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 10 years' experience in health plan operations, provider network engagement and/or hospital or medical staff credentialing.

Preferred

• Minimum 4 years' supervisory experience

• Management experience in a managed care organization or provider practice setting
• Provider relations experience

Knowledge, Skills and Abilities Required
Knowledge

• Strong understanding of Medicaid in a managed care environment
• Understanding of claims, provider directories and provider data
• Understanding of how to manage a production-oriented workforce
• Understanding of credentialing policies & practices
• Understanding of network regulatory reporting, including DSN and HSD tables
• Knowledge of federal Medicare regulations and state Medicaid rules (OARs)

Skills and Abilities

• Skilled in strategic thinking and executing strategy effectively; ability to think at an enterprise level
• Leadership effectiveness and ability to design and implement constructive change
• Strong people management skills, including the ability to coach and motivate teams
• Excellent critical thinking, analytical and problem-solving skills; ability to effectively analyze program goals and objectives to determine successes and opportunities for improvement
• Ability to effectively analyze program goals and objectives to determine successes and opportunities for improvement
• Ability to effectively convey business unit goals and plans ensuring integration into strategic plans and initiatives
• Highly skilled in resource management
• Ability to communicate effectively, both verbally and in writing, including strong presentation and change management skills
• Ability to influence and build consensus
• Ability to work in an environment with matrix reporting, diverse individuals and groups
• 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

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

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.

Work Location: Office - 3 days/week

We 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.