Job Title

Operations Manager - CareOregon Dental

Exemption Status

Exempt

Management Level

Manager

Direct Reports

Referral, Authorization and Access Staff

Manager Title

Director, Dental Operations

Department

Dental

Pay & Benefits

Estimated hiring range $98,390 - $120,250 / year, 5% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits

Posting Notes

Hybrid - 2 days per month at our Downtown Portland office

Job Summary

This position oversees and operationally leads and manages the daily health plan operations for CareOregon Dental, CareOregon’s in house dental plan. This includes management and supervision of dental plan operations staff and related processes; management, contracting and operational oversight of the dental network; access management and network adequacy; regulatory and compliance functions; and participation in state or local workgroups or committees as assigned. This position partners with Dental leadership for cross-departmental operational systems and strategies that impact the internal operations of the in-house dental benefit across CareOregon.

Essential Responsibilities

Operational Leadership

• Oversee the day-to-day operations of CareOregon Dental, including the referral and authorization process and team.

• Analyze, identify, elevate, and resolve complaint, grievance and appeals trends.

• Analyze, identify, elevate, and resolve issues related to referral and authorization, queue management, and related compliance and regulatory requirements. Analyze, recommend, and implement improvements in dental plan operational processes.

• Liaison to other operational department leaders for health plan operations, such as claims, customer service, provider relations as it related to CareOregon Dental; partners with dental leadership for system-level issues, initiatives, and strategies.

• Resolves elevated member issues or complaints.

• Develop internal benefit policies and procedures, standard operating procedures, process guides and other tools for use in program activities.

  Provider Network and Network Adequacy

• Establish ongoing rapport and partnership with the dental provider network.

• Oversee the completion of internal and external processes for provider contracting (primary dental providers and specialty providers) to ensure network adequacy for CareOregon Dental.

• Assist in the resolution of elevated provider issues (e.g., contractual relationships, patient/provider complaints, payment issues, etc.).

• Participate in the development of access goals, review and present achievement of member access goals and make recommendations to department leadership.

• Monitor and review network access and recommend changes that improve patient access and ensure network stability.

  Compliance and Regulatory

• Ensure compliance with authorization, complaint, and grievance/appeals timelines.

• Ensure all compliance and regulatory requirements of the dental plan are completed and submitted timely, including but not limited to the plan DSN, FWA reports, grievance/appeals logs, IRR audits/reports, access monitoring.

• Develop, implement, and maintain the dental plan Quality Workplan in collaboration with department leadership.

  Employee Supervision

• Supervise (or manage) team 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 guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, and decision making.

• Ensure team adheres to department and organizational standards, policies, and procedures.

• 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.

  Experience and/or Education

  Required

• Minimum 5 years’ experience in clinical and/or program operations, including 2 years’ experience leading programs and individuals in an operational setting.

  Preferred

• Bachelor’s degree in Public Health or Health Care Administration or a related field

• Experience with the dental delivery system and oral health Medicaid programs or health plan experience

• Minimum 2 years’ experience in a supervisory position or minimum 1 year experience in a supervisory position with completion of CareOregon’s Aspiring Leaders Program

  Knowledge, Skills and Abilities Required

  Knowledge

• Strong understanding of Oregon Medicaid dental delivery system and FQHC delivery systems

• Strong understanding of health plan financing, health care costs, health outcome measures, and health plan operations

• Understanding of primary and specialty dental clinic operations

• Familiarity with internal quality assessment measures and dental P&Ps

• Knowledge of federal and state regulations related to Medicaid

• Knowledge of Medicaid compliance practices and procedures

  Skills and Abilities

• Ability to develop formal project/program plans to prioritize, manage, and implement tasks, activities, and processes to achieve goals within established timelines

• Ability to create and manage visual displays or maps of complex processes, timelines or projects

• Demonstrated ability to negotiate provider contract language and terms

• Well-developed oral and written communication and presentation skills including ability to articulate concepts to staff, partners, and stakeholders; ability to provide facilitation for groups of people and for the implementation of projects

• People management skills, including the ability to manage, coach, and develop staff.

• Ability to lead, motivate, and guide peers, cross-functional partners, and cross department and network management toward goal attainment

• Ability to develop and maintain excellent professional working relationships with PDPs and Specialists, 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 organize, prioritize, and manage multiple projects

• Ability to support and comply with organizational policies, procedures and guidelines

• Ability to work independently in a rapidly changing environment with diverse individuals and groups

• Ability to work effectively with diverse individuals and groups

• Ability to learn, focus, understand, and evaluate information and determine appropriate actions

• 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

  Working Conditions

  Work Enviornment(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

  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.

  #LI-Hybrid

  Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.

  Veterans are strongly encouraged to apply.

  We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.

  Visa sponsorship is not available at this time.