Program Manager-Provider Contracting

Program Manager-Provider Contracting

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This position is responsible for leading and guiding CareOregon's Provider Contracting to help ensure an effective integrated delivery process focused on contract management, network adequacy and health outcomes. The position works closely with the Provider Contracting team and collaborates with regional and Line-Of-Business (LOB) leadership, population health, actuarial services and Network operations and optimization teams.

This is a hybrid position with the expectation to be in the office 1-2x per month. Priority will be given to candidates located in the Portland Metro area.

Estimated Hiring Range:

$90,225.00 - $110,275.00

Bonus Target:

Bonus - SIP Target, 5% Annual

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

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Essential Responsibilities

• Develop meeting agenda and materials for key providers meetings to support key provider contracting programs.
• Develop and implement education and skills training for the team.
• Develop and maintain data-sharing, meeting, and contract calendars to support existing key programs.
• Develop and enhance with accountability built into workflows and process improvement and incorporate legal contract Subject Matter Expert (SME) review of contracts.
• Develop and implement onboarding training modules for team.
• Create, implement, and operationalize policies to improve processes, including New Contract Signature policy.
• Create and standardize templates for all new contract types across CCO network, aligning principles of Equity, Diversity, and Inclusion (EDI) in collaboration with Legal team.
• Ensure standard and specialized tools and processes are developed, deployed, and reviewed regularly for process improvement to support the various project and programs.
• Operationalize new contract management system, including implementing new workflows and processes incorporating change management and successful use of new system.
• Collaborate with actuarial team and external actuarial consultants on data-sharing and financial reporting to support provider contracts.
• Collaborate with Provider Relations (PRS) team to support continued development and measurement of network adequacy and provider engagement.
• Support collaboration with IS and NCS for development and delivery of enhanced financial reporting for key programs.
• Monitor and support provider contracting reporting regulatory requirements in partnership with the Finance and PRS teams.

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' experience in in program, project, or operations administration; experience should include independent leadership of small, medium, and large complex projects and leading enterprise-wide, complex projects
• Minimum 1 year experience in the healthcare industry

Preferred

• Experience in risk modeling, contracting, network partnership, or related work
• Experience in health plan operations
• Experience with Medicare, Medicaid, or other government healthcare programs

Knowledge, Skills and Abilities Required

Knowledge

• Understanding of provider contracting
• Understanding of shared risk models

Skills and Abilities

• Strong verbal and written communication skills
• Highly proficient in Microsoft Word, Excel, PowerPoint, and Outlook
• Ability to identify and anticipate issues and act proactively to formulate plans and recommendations
• Strong ability to manage multiple activities, organization communications, and competing priorities
• Ability to develop and maintain excellent professional working relationships with internal staff and departments and external stakeholders
• Ability to work with 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
• Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to hear and speak clearly for at least 3-6 hours/day

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.

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.

We are an equal opportunity employer

CareOregon 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.