Planning and Operations Specialist, Senior - Provider Network

This position is responsible for leading, facilitating, and monitoring the planning and operations within the provider network team at a senior level. This includes an advanced understanding and ability to lead and guide the strategic deployment and operational implementation of the strategic plan, projects, and initiatives for the provider network team. This position will attend and participate in meetings on behalf of the provider network operations team. Additionally, this position ensures oversight of network adequacy, satisfaction, and state and federal regulatory requirements as it relates to the provider network. In partnership with department leadership, this position contributes toward the execution of strategic plans within the department and provider-partner network., Projects & Planning

• Monitor and guide the department-wide portfolio of projects and performance dashboard with minimal guidance from department leadership; guide department leaders and cross functional teams in identifying priorities and advancing projects.
• Participate in developing, implementing, and monitoring clinical and/or operational strategy aligned with the organization at large and each line of business, region, or department.
• Identify and lead a process for developing and administering the team’s annual strategic plan and process, as well as underlying goals, projects, strategies, and metrics; influence and negotiate for necessary resources and timelines.
• Develop, collaborate, and implement a monitoring system with visibility to metrics, reporting, and progress toward goals.
• Liaise with other departments relations to costs, planning, and/or deliverables involving complex integration.
• Perform advanced project management skills for provider network initiatives.
• Lead and ensure internal and external stakeholder engagement to move strategies forward.
• Leverage multiple resources to ensure standard and specialized tools and process are developed, deployed, and regularly improved upon to support the various project and programs.
• In partnership with department leadership, implement communications related to provider network.
• Collaborate with network-involved teams to identify process/system areas of improvement.
• Implement standards for monitoring network adequacy and network-related reporting and dashboards.
• Collaborate with data analysts and the quality improvement teams on relevant network-related data.

Operations

• Inform, develop, and lead the operational infrastructure to help ensure Provider Engagement and the provider network is operating as efficiently as possible and delivering the highest quality services to its customers.
• Educate and ensure staff understand the overall clinical and/or operational strategy and their role in supporting this work.
• Lead team in working effectively across departments, regions, and lines of business within a matrix structure.
• Build, deploy, and lead communication systems and effective communication forums and pathways to guide cross-functional relationships.
• Develop and lead the Provider Engagement and provider network operations’ meeting infrastructure, including content, tracking, and reporting on deliverables; staff senior leadership meetings and external meetings at the executive and operational level; attend and participate in meetings on behalf of business unit leaders.
• In partnership with department leadership and other senior leadership, identify content and presentations for enterprise-wide meetings.
• Organize and manage activities such as retreats, team development, and other forums to ensure collaboration and cohesion.
• Inform data analysts of core data needs; collaborate to extract and present relevant data internally and externally.
• Identify, implement, and train on departmental improvements for operational policies, procedures, and documentation.

Required

• Minimum 5 years’ experience in planning, operations, project, or program administration, including 2 years’ experience leading large, complex, and diverse multi-stakeholder collaborations within provider network operations
• Experience as an influential communicator and creative problem solver across teams and within a complex orgnaizational structure
• Education or training in LEAN or related process improvement techniques

Preferred

• Program, project, or operations administration experience working in a healthcare system, clinical delivery system, or managed care organizations (Medicaid and/or Medicare)

Knowledge, Skills and Abilities Required

Knowledge

• Advanced understanding of principles, methods, and techniques of project management
• Strong understanding of quality assessment measures
• Strong understanding of Oregon Medicaid or Medicare in area of focus
• Strong understanding of techniques used in change management
• Knowledge of healthcare terminology
• Strong understanding of health system operations
• Strong knowledge of information systems used in health systems to support clinical care and quality improvement initiatives
• Knowledge of health plan financing, health care costs, health outcome measures, and health plan operations
• Strong knowledge of Medicaid and Medicare regulatory and contractual requirements
• Understanding of provider development, education, and relations

Skills and Abilities

• Strong computer application skills, including with Microsoft 365 Office products (Word, Excel, Outlook, PowerPoint, etc.), and Microsoft and Google-based internet browsers and search functions
• Excellent verbal and written communication and presentation skills, including ability to articulate concepts to staff, partners, and stakeholders
• Strong facilitation and stakeholder engagement skills
• Skilled at conducting trainings, meetings, and presentations, both virtual and in-person
• Excellent organizational skills; ability to apply process improvement techniques to department operations and create efficiencies
• Proficiency in developing and facilitating strategic planning processes and a visible ongoing monitoring system for a variety of initiatives
• Results-oriented with a high attention to detail, ability to multi-task, and meet deadlines in a demanding, fast-paced environment
• Strong ability to develop, recommend, and implement policies, procedures, and guidelines
• Ability to synthesize large volumes of information and data points into a set of deliverables
• Excellent ability to develop formal project/program plans and prioritize, manage, and implement tasks, activities, and processes to achieve goals within established timelines
• Ability to create and manage visual displays or maps of processes, timelines, or projects
• Ability to lead, motivate, and guide peers, cross-functional partners, and cross department and network management toward goal attainment
• Ability to develop and maintain strong professional working relationships with internal staff and departments and external stakeholders
• Ability to effectively solve unique problems as they arise or identify when to direct issues to appropriate department/supervisor
• Ability to create and manage visual displays or maps of processes, timelines, and/or projects
• 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

Pulled from the full job description

• Pet insurance
• AD&D insurance
• 401(k)
• Health insurance
• Paid time off
• Vision insurance
• Health savings account, 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 and/or mobile technology

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: Hybrid-Office 2 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.