Provider Relations Representative, Oral Health

• Oversee the dental care network managed by the delegated entity ensuring compliance with contractual obligations and performance standards.
• Monitor and report on key metrics such as accessutilization quality measures and member satisfaction.
• Conduct regular reviews of delegated entity operations to ensure adherence to Umpqua Health policies and regulatory requirements.
• Ensure delegated entity meets all contractual requirements including reporting credentialing and quality benchmarks.
• Collaborate with internal teams to address gaps in performance and implement corrective action plans when necessary.
• Maintainaccuratedocumentation of oversight activities and prepare reports for leadership and regulatory agencies.
• Serve as a resource for oral health providers within the network addressing inquiries and resolving issues related to claims credentialing and operational processes.
• Deliver training and education to providers on Umpqua Health initiatives compliance standards and oral health program requirements.
• Assistin the development and implementation of oral health programs aimed at improving preventive care member engagement and overall health outcomes.
• Support initiatives that integrate oral health with primary care and behavioral health services.
• Partner with internal departments such as Compliance Quality and Network Development to ensure alignment of oral health strategies with organizational goals.
• Participate in meetings with delegated entity leadership to review performance and discuss improvement opportunities.

• Working with a variety of personalities maintaining a consistent and fair communication style.
• Satisfying the needs of a fast-paced and challenging company.

• Bachelors degree in healthcare administration Business Public Health Communications or a related field
• Minimum of 3 years of experience as a Provider Relations Representative Network Manager or similar role within a Medicaid MCO or dental benefits administrator
• Minimum of 5 years of hands-on experience working with dental providers (e.g. solo practices group practices or clinics serving Medicaid populations) including dental practice management multi-site operations or provider outreach
• Strong knowledge of Medicaid Managed Care principles including provider contracting dental claims and billing processes (CDT codes) prior authorization and regulatory compliance standards (e.g. NCQA HEDIS Dental Quality Alliance measures)
• Familiarity with Oregons Coordinated Care Organization (CCO) model and Oregon Health Plan (OHP) dental benefits
• Proven ability to conduct provider education training sessions site visits and resolve issues such as claims disputes policy questions and billing support
• Strong communicationand relationship-building skills
• Strong analytical and problem-solving abilities including monitoring performance metrics and compliance
• Proficiencyin Microsoft Office Suite and ability to learn provider systems
• Ability to manage multiple priorities work independently and meet deadlines in a field-based environment
• Ability to interpret and enforce contractual requirements and regulatory standards
• Ability to collaborate effectively with internal teams and external partners
• Able to travel on-site

PREFERRED QUALIFICATIONS

• Dental-related certifications
• Medicaid-specific training
• Experience with value-based care models for oral health
• Experience with delegated network oversight
• Experience supporting oral health integration initiatives ( pediatric coordination)
• Demonstrated experience working with diverse and rural provider populations

• Salary is dependent on skills experience and education
• Generous benefits package including vacation PTO sick leave federal holidays and birthday leave
• Medical dental and vision insurance
• 401(k) with company match (fully vested immediately)
• Company-sponsored life insurance and additional benefits
• Fitness reimbursement program
• Tuition reimbursement and more