Director, Provider Data Management

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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.

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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.
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