Providence Health & Services Manager Behavioral Health Network in Washington
Providence Health Plan is calling a Manager Behavioral Health Network to our location in Portland, OR. This position will be remote and may pivot to a hybrid model in 2022 working a combination of in office and remote.
We are seeking a Manager Behavioral Health Network to be responsible for the development, management and servicing of a Providence Health Plan-affiliated network of behavioral health care providers for all health plan products in Oregon and SW Washington servicing all lines of business including, but not limited to, the Commercial, Medicare, Medicaid and Providence Preferred. The Manager is responsible to develop and assure network adequacy. They are responsible for the ongoing relationship between the Health Plan and its network partners in the service area(s). In addition, the Manager provides leadership and is a resource in the standardization of provider service standards and interpretation of health plan operational policy statewide.
This position is responsible for assuring that the provider contracts are in compliance with regulatory agencies including, but not limited to, CMS, state and federal parity, state insurance commissions and accreditation programs and that the files of these contracts and associated correspondence meet the requirements of these agencies. The manager is responsible for the negotiation of parts or all of many hospital, practitioner, and ancillary contracts for all product lines in a highly competitive environment.
The Behavioral Health Network Manager must actively seek out changes required in contract provisions by HCS, Finance, Regulatory Compliance, Corporate Legal, and other departments as well as external agencies such as NCQA, DCBS, OIC, and CMS. He or she must verify that the PHP, PPO, PPP, and MCO contracts and incorporate changes required. This position oversees the review of both new and renewing contracts by the BH Network Services team. Review is for accuracy and consistency with other contracts in a region and with the Providence Health System. Manager is responsible for maintaining the inventory of existing Providence Health Plan, PPO, PPP, and MCO provider contracts.
New payment methodologies will be assessed for operational workability and will be accurately reflected in contract documents
In this position you will:
- Develop and manage Oregon and SW Washington network of affiliated health systems, hospitals, IPAs, physician groups, and other health care professionals.
Required qualifications for this position include:
Bachelor's Degree in Business Administration, Finance, Healthcare Administration, Nursing -OR- equivalent education/experience.
Valid Oregon or Washington driver's license.
3 years progressively responsible experience in managed healthcare.
3 years Supervisory Experience.
3 years experience in managed care contract negotiations with IPAs, medical groups, independent physicians, hospitals, health systems, and physician hospital organizations.
History of positive working relationships with providers, especially physicians, that demonstrates credibility and trust.
Detailed understanding of contract issues involved in provider credentialing, regulatory requirements, hold harmless clauses, patient access and grievance, operational parameters, contract assignment language, a variety of payment methodologies, and several different risk and incentive arrangements.
About Providence in Oregon.
As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities.
The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple,
"Providence will provide the best care and service to every person, every time."
Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.
We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Clinical Lead Supervisor/Manager
Other Location(s): Washington, Oregon
Req ID: 329183