Provider Data Manager

Overview

The provider data manager is responsible for overseeing the strategic management and optimization of contracted and non-contracted provider network data within the Network Operations Division. This role ensures comprehensive data collection, quality assurance of provider data, quality improvement initiatives focused on improved data accuracy, and alignment with state and federal requirements. The provider data manager is a people leader who manages the day-to-day operations of the team, including performance and productivity management.

Key Care Oregon stakeholders include Provider Engagement, Credentialing, Operations, Clinical Leadership, Compliance, Information Systems & Business Intelligence, and Regulatory Affairs.

$ - $

Bonus - SIP Target, 5% Annual

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

• Responsible for accurate and timely provider network data within the claims processing system, including contract status, specialties, locations, and credentialing information.
• Ensure upstream and downstream data acquisition is aligned with system configuration and can be operationalized for accurate claims payment and directory presentation.
• Analyze provider data to identify trends, gaps, and opportunities for improvement.
• Facilitate quality improvement projects designed to enhance provider data collection and storage.
• Ensure that all provider data programs are in compliance with applicable healthcare regulations, including the Oregon Health Authority and the Centers for Medicare & Medicaid Services.
• Develop and participate in business planning, budgeting, and operational performance target management.
• Manage cross-functional projects related to provider network data, ensuring that project goals, timelines, and budgets are met.
• Develop and oversee policies and procedures, incorporating best practices and ensuring consistency.
• Monitor and track team metrics through the creation of monthly quality and productivity reports.
• Ensure project deliverables are met according to quality control schedules and standards.
• Coordinate the compilation and submission of state and federal required provider data reporting such as OHA DSN capacity report, CMS Network Adequacy, HSD table creation, and HEDIS Roadmap.

• Develop and monitor key performance indicators for the department overall and department staff.
• Align department priorities with enterprise initiatives.
• Serve as the Operations product owner for the underlying provider directory data.
• Coordinate the provider data team’s communication with external customers regarding provider information, provider status, claims administration as it relates to provider setup, and responses to changes in the business or regulatory environment.
• Represent department in plan governance functions.

• Establish and maintain cooperative and productive working relationships with internal and external stakeholders.
• Coordinate timely and accurate responses to internal and external audits (e.g., OHA, HSAG, CMS, KPMG).
• Represent Care Oregon in industry work groups (e.g., QUsers Group Provider Data Workgroup).
• Conduct product and vendor research and present recommendations to team and management.
• Manage vendors, including ongoing business reviews and performance management.
• Represent Care Oregon at the All Plan System Tech meeting.

• Manage teams and recommend team direction and goals in alignment with the organizational mission, vision, and values.
• Identify work and staffing needs to meet work expectations; recruit and hire using an equity, diversity, and inclusion lens.
• Plan, organize, schedule, and monitor work; 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.
• Train, supervise, motivate, and coach employees; provide support toward employee development.
• Incorporate…