CareOregon Hiring for Sr Vice President, Network Management at Portland, OR  Full Time

Job Summary

This position serves as the primary representative and leader of strategic and operational integration for network management for the CareOregon enterprise. Activities are anchored in developing and managing provider-partner relationships to advance CareOregon’s clinical strategy to improve population health and achieve identified quality and health outcomes for members. Primary duties include strategic leadership, planning, provider communications, engagement, and relationships, financial management and guidance, and development and oversight of effective teams.

Essential Responsibilities

Technical/Strategic Leadership

• Provides strategic leadership through the development of the CareOregon Provider Network across all lines of business, including Medicaid, Medicare, Behavioral Health Dental Health, and other benefits (as applicable).
• Develops, implements, and maintains measures for each line by directing activities related to clinical network development, provider education, provider relations and maintaining excellence in overall network management activities.
• Provide direction and departmental oversight for staff engaged in developing provider relationships to facilitate access and highly effective care for members.
• Evaluate and advise on the impact of long-range planning, introduction of new programs/strategies and regulatory action on provider network.
• Provides input/expertise to enterprise member engagement strategy and activities and supports integration of provider and member engagement strategy.
• Drives integration and communication of provider network and contract changes to internal and external stakeholders.
• Provides input and/or expertise as needed for clinical and operational teams that engage the provider network by ensuring that each region has sufficient access, achieves quality outcomes, and executes on network strategies that advances strategic clinical programs/projects.
• Oversees the provision of technical assistance strategies for the provider network, including collaboratives, learning sessions, and committees/workgroups.
• Provides input/expertise to VBP/Contracting teams who are implementing operational, clinical, and alternative payment initiatives that assures CareOregon is strategically positioned to support its current and future provider network and strategic partners.
• Provides expertise, leadership to medical management department to ensure medical management activities are aligned with network management strategies.
• Guides intersections across matrixed teams, including utilization management/authorizations, enrollment, claims, A&G, payment integrity, and quality assurance.
• Ensures effective network monitoring and measurement, including adequacy, accessibility, compliance, and regulatory reporting.
• Ensures effective education and onboarding systems and methods are in place for network partners.
• Leads regulatory interpretation, requirements definition, and optimized processes for provider processes and tools including:
  • Member – Provider Assignment & Attribution
  • Provider self-service channels such as provider portal
  • Claims Systems Configuration and Changes
  • Provider Directories
  • Interoperability/Provider Data & Integration
  • Provider Communications
  • Provider Network Adequacy
• Supports emerging opportunity assessments involving the creation or onboarding of new companies or new strategic partnerships.
• Identifies and oversees network management investments and costing decisions aligned with organizational strategic priorities.
• Advises executive leadership on emerging market trends and best practices for network management solutions.
• Serves as Executive Sponsor for key projects and initiatives.
• Ensures and measures customer value, satisfaction, reliability, and continuous improvement of the CO network.
• Promotes a culture of continuous improvement, service, and accountability while developing staff and leaders.

Strategic Planning

• Establishes CareOregon’s approach to the network based on member population needs and the desired member health and experience outcomes and impact.
• Actively and regularly participates in strategic planning and collaboration at the organizational level.
• Provides counsel to the organization’s executive leadership on specific areas of short and long-term planning related to network development.
• Leads the development of vision and goals for areas of oversight.
• Maintains a deep understanding of CareOregon operations and strategic functions, their strengths as well as internal or external threats.

Financial/Resource Management

• Develops, proposes, and oversees substantial budgets in alignment with strategic planning and organizational needs.
• Counsels on financial and labor allocations across the organization, including people, finances, and timelines.

Relationship Management

• Develop, implement and manage strategic relationships with provider stakeholders that includes innovative network arrangements and health outcome accountability.
• Ensures strategic messages are regularly and effectively relayed to appropriate internal and external stakeholders.
• Collaborates with other departments in the development and implementation of new care models that requires ongoing network management.
• Builds and maintains strategic relationships relating to network resilience, quality improvement, innovation, LOB/regional boards and committees, CAPs, clinical integration programs, funding, assessment, and evaluation.

Employee Supervision

• Directs teams and establishes team direction and goals in alignment with the organizational mission, vision, and values.
• Identifies work and staffing models; recruits, hires, and oversees a team to meet work needs, using an equity, diversity, and inclusion lens.
• Identifies department priorities; ensures employees have information and resources to meet job expectations.
• Leads the development, communication, and oversight of team and individual goals; ensures goals, expectations, and standards are clearly understood by staff.
• Manages, coaches, motivates, and guides employees; promotes employee development.
• Incorporates guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, budgeting, resource allocation, and decision making.
• Ensures team adheres to department and organizational standards, policies, and procedures.
• Evaluates employee performance and provides regular feedback to support success; recognizes strong performance and addresses performance gaps and accountability (corrective action).
• Performs 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.

Experience and/or Education

Required

• Minimum 10 years of network leadership experience in managed care and innovative care models
• Minimum 5 years’ experience in a supervisory position

Preferred

• Bachelor’s or Master’s degree in Public Health, Health Care Administration, or related field

Knowledge, Skills and Abilities Required

Knowledge

• Advanced knowledge of managed health care, applicable laws, and relationship value with provider networks
• Advanced knowledge of clinical workflows and electronic health record systems within primary care
• Thorough knowledge of principles and statistical methodologies for program assessment and evaluation
• Strong understanding of financial structures, fiscal responsibility, and the economic impact of business decisions

Skills and Abilities

• Ability to negotiate and execute complex contractual relationships to align with specific corporate initiatives, strategies, goals, and objectives
• Exceptional relationship-building skills to promote an open and positive atmosphere
• Excellent presentation skills; ability to speak clearly and persuasively in positive or negative situations
• Ability to effectively communicate verbally and in writing organizational mission, vision, and goals to all levels of the organization
• Ability to develop and lead high performing teams, including hiring, goal setting, coaching, performance management, and development
• Ability to make complex and timely decisions, exhibiting sound and accurate judgment
• Extensive data analysis skills derived from formal statistical knowledge and training
• Strong analytical and problem-solving skills

• 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 hear for at least 6 hours/day
• Ability to speak clearly and perform repetitive finger and wrist movement for at least 3-6 hours/day

Working Conditions

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.

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.

Equal opportunity employer. This company considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.