Location : Hybrid. Most of the positions at YCCO are hybrid, meaning they have the flexibility to work both remotely and/or in-person at YCCO's office in McMinnville, OR.

Department: Health Plan Operations FLSA Status: Exempt

Reports To: Provider Network Manager Physical Strength: Light (L)

About Us: Yamhill Community Care is a nonprofit coordinated care organization dedicated to managing the healthcare for Medicaid members, covered under the Oregon Health Plan, in Yamhill County, as well as parts of Washington and Polk Counties. Our mission is to improve the quality of life of the communities we serve by coordinating effective care. Beyond healthcare, we also provide an Early Learning Hub, supporting families and children with essential resources and programs for early childhood development. Together, we're building a unified healthy community that celebrates physical, mental, emotional, spiritual, and social well-being.

Learn more about Yamhill Community Care:click here

Summary

The Provider Network Specialist serves as a resource for the Yamhill Community Care (YCCO) network and is a liaison between the provider network and internal departments. This position serves as a point of contact for providers and appropriately escalates network concerns, compliance issues, and contracting requests to the appropriate internal resource when warranted. The Provider Network Specialist works across departments to ensure proper communication regarding provider network issues and concerns are properly addressed and mitigated.

Essential Duties

1. Collaborates with providers and community stakeholders to improve regional access and availability of healthcare services and ensures network adequacy and compliance.
2. Acts as a liaison between internal and external partners ensuring responsibility for the development and monitoring of network plans, reports, and other initiatives.
3. Develops resources and communication tools to support provider network compliance.

Job Duties

• Develops and executes strategies to ensure network adequacy.
• Convenes cross system/sector partners inclusive of YCCO staff, health systems, and community stakeholders to develop and coordinate the availability and access to quality health care services.
• Ensures subcontracted services and delegated network activities meet all regulatory and contractual requirements, including billing and coding.
• Collects and synthesize data, tracking, and reporting on network-related contractual requirements, supports monitoring and evaluation activities.
• Support the appropriate coverage and delivery of services within Tribal providers and partners.
• Development and maintenance of network policies and procedures including but not limited to provider handbook, ensuring accuracy and maintenance of provider directory, and other materials as identified.
• In partnership with internal departments, develops, and sustains relationships with network providers with an enhanced focus on those holding a value-based agreement.
• Responsible for facilitating quality initiatives, participating in improvement plans, and projects related to assigned functional areas within the provider network.
• Oversight of network reporting requirements.
• Contributes to the ongoing review and analysis of the provider network and systems and identifies opportunities for improvement.
• Holds the role of a technical information lead to the network to support understanding of provider scopes of work, care model, and oversight responsibilities.
• Develops educational collateral and materials describing scope of service, benefits, and availability for the provider network, members, community partners.
• Offers technical assistance to providers as requested.
• Initial point of contact to ensure compliance with state, federal, and provider contract requirements.
• Works cross-departmentally to address provider concerns and issues requiring escalation.

Essential Department & Organizational Functions

• Works to cultivate and develop inclusive and equitable services, and working relationships with diverse groups of employees, community partners, and community members.
• Participates in the preparation and submission of regulatory and contract required deliverables.
• Works closely with other YCCO departments, including Health Plan Operations and Compliance to assist with audits; including the External Quality Review (EQR), as needed.
• Proposes and implements process improvements.
• Meets deadlines for completion of assigned responsibilities and projects.
• Maintains agreed upon work schedule with punctual, regular, and predictable attendance.
• Attends in person Annual Company Conference in McMinnville, OR; typically held in the fourth week of September.
• Demonstrates cooperation and teamwork using a professional and respectful demeanor.
• Provides cross-training on specific job responsibilities.
• Meets identified goals that contribute to departmental goals.
• Works collaboratively in a team and matrixed (cross-department) environment with a spirit of cooperation.
• Respectfully takes direction from Supervisor.
• Performs other duties as assigned.

**Knowledge, Skills, & Abilities **

• Ability to write and edit content for written reports and presentations.
• Ability to communicate effectively in all forms of communication.
• Ability to analyze, collect, prepare, and distribute appropriate materials for meetings as assigned.
• Knowledge of how to locate, assemble, edit, and summarize materials, information and data as requested.
• Excellent listening, interpersonal and customer service skills.
• Knowledge of community resources.
• Knowledge of barriers to care such as language, cultural factors, transportation, ability to self-manage and psychosocial issues and bring those to the attention of the care team.
• Knowledge of Oregon Health Plan (OHP) benefit package and OHA rules and regulations as they pertain to coordinated care organizations.
• Excellent organizational skills including ability to handle multiple priorities and demands simultaneously in a dynamic work environment while maintaining high attention to detail and accuracy.
• Ability to work independently, use sound judgment, anticipate next steps and be proactive as part of a diverse team within a Matrix or shared resources across departments work model.
• Excellent computer skills, including Microsoft Windows, Word, Excel, and Outlook.
• Ability to communicate both professionally and effectively in all forms of communication.
• Ability to work in an environment with diverse individuals and groups.
• Ability to remain flexible, positive, and adaptable.
• Ability to work across the YCCO region and to work remotely, as needed.

Supervisory Responsibilities

This position has no supervisory responsibility.

Qualifications

Ability to perform essential job duties with or without reasonable accommodation and without posing a direct threat to safety or health of employee or others. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation(s) may be made to enable individuals with disabilities to perform the essential duties.

Education & Experience

Required:

• Bachelor’s degree
• Minimum of two (2) years’ program coordination in provider network compliance and/or operation

OR:

• Any combination of education and experience that would qualify candidate for the position.

Preferred:

• Experience with provider network adequacy and performance

Certificates, Licenses and/or Registrations

This position does not require any certificates, licenses, or registrations.

Physical Demands & Work Environment

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties of this position. The work environment characteristics described here are representative of those an employee encounters while performing the essential duties of this position. Reasonable may be made to enable individuals with disabilities to perform the essential duties.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit, stand, walk, use hands and fingers, handle or feel, and reach with hands and arms. The employee is occasionally required to climb or balance, stoop, kneel, crouch or crawl. The employee may occasionally need to lift and/or move up to 25 pounds.

This position operates in a professional office environment and requires frequent use of standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. Specific vision abilities required by this job include close vision, color vision, distance vision, depth perception, and ability to adjust focus. The noise level in the work environment is usually moderate.

This position may include occasional required or optional travel outside of the workplace, in which the employee’s personal vehicle, local transit, or other means of transportation may be used.