The Policy Management Specialist is responsible for developing, implementing, and supporting CareOregon's enterprise wide Policy Management Program. Core areas of focus include assisting staff in writing quality and compliant polices, serving as administrator for PolicyTech software, monitoring to ensure policies are current, developing efficient processes, training staff

Career Opportunities IS Application Systems Administrator I (24263) Requisition ID 24263 Posted 05/08/2024 CareOregon Full Time Permanent Portland Multi Location (9) Job Description Print Preview Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin. Position Title IS Applications Systems Admini

This position is responsible for proactively identifying opportunities and developing algorithms, models, data structures and data products to facilitate production of insights from healthcare claims, enrollment, and other related data. The core function of this position is to translate complex data into meaningful information for decision makers. Focus areas include cost

This position is responsible for performing compliance monitoring of sub contracted organizations, working collaboratively with departments across CareOregon. Primary responsibilities include delegation oversight, process improvement, and reporting. Essential Responsibilities Delegation Oversight Work at the guidance of and with input from the Regulatory Manager to interp

The Health Care Coordinator (HCC) acts an entry point to CareOregon's Regional Care Teams, as well as provides care coordination. This position provides intake functions, physical and behavioral health plan navigation, and care coordination including assessing member needs, developing individualized care plans, coordinating with providers and with members. A focus of this

This position serves as a primary liaison between CareOregon and the provider partner network, which includes contracted, non contracted, and potential providers. This position focuses on establishing, building, and strengthening provider partner relationships among contracted providers. Primary responsibilities include an intermediate level of provider onboarding, develo

This position performs data analysis at an intermediate level. Essential responsibilities are aligned with practices and teams within a defined geographic area, coordinated care organization (CCO), benefit or line of business and may provide guidance to less experienced analysts. This position spends substantial time using a combination of evaluation, quality improvement

This position is responsible for performing a wide variety of financial and actuarial analyses impacting strategic decision making and the company's financial sustainability efforts. Areas of analysis include cost and utilization trend analysis, return on investment evaluations, Medicare bid development, rate setting optimization, forecasting support, benchmarking, risk a

The Senior Pharmacy Clinical Coordinator is responsible for coordinating with staff and providing pharmacy oversight of a line of business (LOB) (i.e., Coordinated Care Organization (CCO)) or the pharmacy network (i.e., clinical and community pharmacists). Responsibilities include developing and delivering clinical and educational interventions designed to improve pharmac

The Medicare Encounter Data Analyst leads the process for the end to end Encounter Data Processing System (EDPS) data flow and works within CMS guidelines for acceptable data submission. Using SQL and SAS programs, monitor submissions of core claims and supplemental data and reconcile against CMS response files. This position influences leadership decision making and prov

This position is responsible for working with CareOregon members, their providers, and pharmacies to support the pharmacy benefit and prescription needs under the major medical benefit. This is an advanced level support position, requiring Pharmacy Technician Certification. Core responsibilities include customer service, claims processing, prior authorizations, formulary

This position serves as a primary liaison between CareOregon and the provider network, which includes contracted, non contracted, and potential providers. This position focuses on establishing and supporting consistent and reliable provider network relationships. Primary responsibilities include triaging, monitoring, and coordinating provider requests, with a specific foc

The Oregon Department of Environmental Quality strives to build and sustain an inclusive environment that embraces and values diversity. Employees at all levels of the agency work together to foster fairness, equity, inclusion, and belonging. We are an equal opportunity employer and do not discriminate based on race, color, national origin, ethnicity, veteran, gender, sex

At The Commerce Bank of Oregon, we're a community of professionals with relationships at our core. We strive to promote an engaging environment with accessible leadership and on going employee development. Our workplace culture is based on inclusivity and collaboration, so we can give our customers, as well as our employees, the best possible environment to thrive. We are

2024 Paid Summer Internship The Commerce Bank of Oregon, a division of Zions Bancorporation, is currently seeking College/University students to fill summer internship positions. The internship is a paid, full time in person position located in Portland, OR and is part of an 8 week program. The Internship Programgives students the opportunity to gain valuable and practica