Managed Care Provider Relations Manager jobs in Springfield, OR

Umpqua Health is an equal opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and the needs of the business. Our dedication to fairness and equality extends to all aspects of employment, including hiring, training, promotion, and compensation, without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law.

As the Manager of Provider Relations, you will lead efforts to build and maintain strong relationships with healthcare providers, ensure network adequacy, and enhance provider performance. Reporting to the reporting to the Sr. Director, Engagement and Relations, you will oversee network development, provider relations, network adequacy monitoring, and provider education initiatives to support organizational objectives. As the Manager of Provider Relations, you will play a critical role in building a robust provider network, fostering positive relationships, ensuring network adequacy, and providing ongoing support and education to our provider community.

• Lead strategic initiatives to develop and expand the provider network, ensuring coverage adequacy and geographical access for our members.
• Identify and pursue opportunities to recruit new providers, negotiate contracts, and establish partnerships with healthcare organizations to enhance network breadth and depth.
• Work closely with provider contracting activities, including negotiating contracts, fee schedules, and reimbursement rates to ensure competitive and mutually beneficial agreements.
• Ensure that provider contracts align with organizational goals, regulatory requirements, and industry standards, and liaise with legal counsel and finance for contract review and finalization.
• Serve as the primary point of contact for healthcare providers, addressing inquiries, resolving issues, and fostering positive relationships.
• Develop and implement provider engagement initiatives, including regular communication, provider education sessions, and forums to promote collaboration and address mutual concerns.
• Establish and maintain network adequacy standards based on regulatory requirements and industry best practices.
• Conduct ongoing monitoring and analysis of network adequacy metrics, including provider-to-member ratios, geographic accessibility, and appointment availability.
• Identify network deficiencies and work with internal teams to develop strategies for addressing gaps and ensuring network compliance.
• Develop and deliver training programs and educational materials to the provider community, focusing on topics such as utilization management, quality improvement initiatives, and regulatory compliance.
• Collaborate with internal subject matter experts to ensure training content is accurate, relevant, and aligned with organizational goals and priorities.
• Evaluate training effectiveness and solicit feedback from providers to continuously improve educational offerings and support provider performance.

• Bachelor's degree in Healthcare Administration, Business Administration, or related field (Master's degree preferred).
• Minimum of 5 years of experience in provider network management, provider relations, or healthcare contracting, with at least 2 years in a managerial or leadership role.
• Strong understanding of managed care principles, healthcare reimbursement models, and provider contracting strategies.
• Excellent negotiation, communication, and interpersonal skills, with the ability to build and maintain relationships with diverse stakeholders.
• Demonstrated leadership abilities, including the ability to lead and motivate a team, prioritize tasks, and achieve organizational goals.
• Knowledge of regulatory requirements, accreditation standards (e.g., NCQA), and industry best practices related to provider network management.
• Proficiency in Microsoft Office Suite and healthcare management software.

Umpqua Health is an equal opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and the needs of the business. Our dedication to fairness and equality extends to all aspects of employment, including hiring, training, promotion, and compensation, without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law.