Job Description

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.

COVID-19 Update for Prospective Employees: YCCO is no longer requiring COVID-19 vaccination for employees.

Department: Heath Plan Operations FLSA Status: Exempt

Reports To: Health Plan Operations Sr. Director Physical Strength: Light (L)

Learn more about Yamhill Community Care:

Summary

The Network Benefits Manager is responsible for management of Yamhill Community Care\xe2\x80\x99s (YCCO) network benefits functions, including provider network, benefit systems, claims payment activities, monitoring and compliance to ensure services and supports are available within the YCCO network. Responsibilities include attending to day-to-day operations, oversight of and collaboration with contracted providers, partners, and the Oregon Health Authority by performing the following duties.

Essential Duties * Partners with the Leadership and Management teams in developing, engaging, and maintaining contracted networks, payment structures, and business strategy for YCCO.

• Oversees the integration of provider network systems, structures, initiatives, and deliverables embodied in YCCO\xe2\x80\x99s contract and operating plans.
• Oversees operational compliance and risk management activities of YCCO\xe2\x80\x99s contracted networks and Affiliate partnerships with YCCO, including the contractual relationship with the Oregon Health Authority.

Job Duties

• Collaborates in the development and maintenance of a comprehensive provider network and delivery system that provides high quality and cost-effective service to YCCO members.
• Leads development efforts to integrate systems and engage providers across physical, behavioral, and oral health, in collaboration with the Leadership and Management teams.
• Ensures outcomes are tracked by provider(s) and by health service areas as required by contract, rule, or other regulatory guidance.
• Provides leadership for staff and departments and other community partners in a manner that is consistent with organizational Vision and Mission to achieve YCCO\xe2\x80\x99s strategic and transformational goals.
• Helps establish and effectively execute operational strategies and reporting that comply with all requirements set forth in the YCCO Health Plan Service contract, including State and Federal requirements.
• Provides strategic and tactical leadership to Operational committees and workgroups.
• Develops and maintains organizational administrative policies and procedures.
• Design and development of processes to ensure compliance with contract requirements including, but not limited to, network adequacy, access, provider selection, claims and encounter systems, community partner engagement, and compliance with OARs and other regulatory standards, as assigned.
• Leads the ongoing review and analysis of the provider network and systems, identifying opportunities for improvement.
• Participates in improvement plans and projects related to assigned functional areas. Provides operational content expertise and technical assistance to YCCO\xe2\x80\x99s staff, partners, and provider organizations.

Management & Leadership

• Ensures program expectations and standards are clearly understood by unit staff.
• Provides staff with the training, tools, and resources necessary to carry out their work.
• Analyzes staff productivity and quality, reorganizing and distributing work assignments needed.
• Supervises assigned unit staff in a consistent manner.
• Evaluates unit employees\xe2\x80\x99 performance both informally and formally and takes corrective action to address areas of opportunity.
• Performs human resource functions in collaboration with the Manager and Human Resources department.

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 Quality Assurance 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.
• 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.
• Other duties as assigned.

Knowledge, Skills, & Abilities

• Knowledgeable in managed care, OHP benefits, behavioral health systems, Oregon Administrative Rules (OAR), Oregon Statute (ORS), and CCO requirements.
• Strong report and policy development and writing skills.
• Ability to communicate project status and issues to Director in a timely manner.
• Ability to remain flexible, positive, and adaptable.
• Ability to build productive working relationships, problem solve and resolve conflicts successfully.
• Ability to work in transformational systems.
• Ability to communicate both professionally and effectively in all forms of communication, facilitation, and customer service skills.
• 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 use critical thinking skills in problem solving.
• Ability to work across the YCCO region and to work remotely, as needed.
• Ability to build and maintain professional relationships with community stakeholders.
• Skills in project management, group facilitation, community organizing and systems-thinking.
• Possess a high degree of initiative and motivation along with the ability to effectively collaborate and plan with others.
• Ability to focus on and comprehend information, learn new skills/abilities, assess situations, and determine appropriate resolution, accept direction, and feedback, and manage stress.
• Ability to work in an environment with diverse individuals and groups.

Supervisory Responsibilities

Directly supervises employees in the Health Plan Operations department. Carries out supervisory responsibilities in accordance with the organization\'s policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

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 accommodations may be made to enable individuals with disabilities to perform the essential duties.

Education & Experience

Required:

• Five (5) years of experience in healthcare or business administration, clinical operations, or related field
• Two (2) years of supervisory experience

OR:

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

Preferred:

• Degree in business administration, healthcare administration or related health field.
• Experience working with the Oregon Health Plan

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 accommodations 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\xe2\x80\x99s personal vehicle, local transit, or other means of transportation may be used.

Yamhill Community Care