CareOregon

Data Engineer

• Perform data warehouse architecture or enterprise data architecture at a senior level
• Design and development of data models and ETL specifications
• Data analysis, system design and architecture, standards and policy administration
• Vendor coordination and relations

IS Data Warehouse Architect – III

Backend Engineer

• Provide health system navigation and short-term care coordination
• Conduct proactive member outreach to identify and assess care coordination needs
• Determine and address navigation, care coordination and/or resource needs
• Coordinate referrals as applicable
• Collaborate and facilitate services that meet member needs with healthcare providers
• Document all related activities in the centralized care coordination platform

Care and Outreach Specialist, Telephonic, Temporary

• Create, maintain and optimize data pipelines for specific use cases
• Manage data pipelines through stages, from ingestion of data sources to consumption
• Utilize tools and techniques to automate tasks, minimizing manual processes
• Assist with renovation of data management infrastructure
• Partner with Information Systems teams and data consumers to refine data requirements
• Train data and analytics consumers on data pipelines and preparation techniques
• Propose data ingestion, preparation, integration and operationalization techniques
• Promote CareOregon’s data and analytics capabilities to staff and leadership

Actuary

• Performing a wide variety of financial and actuarial analyses impacting strategic decision making and the company’s financial sustainability efforts
• Conducting cost and utilization trend analysis
• Return on investment evaluations
• Medicare bid development
• Rate setting optimization
• Forecasting support
• Benchmarking
• Risk adjustment optimization
• Provider payment evaluation
• Reviewing actuarial estimates
• Identifying opportunities for improved financial performance
• Collaborating with Information Systems to ensure access to a data source with high data integrity
• Providing training and support to other Finance users

Senior Actuary

Financial Planning and Analysis

• Lead the alignment of the organization’s financial strategy with business strategy
• Provide guidance over a full spectrum of strategic and tactical programs to support financial objectives
• Ensure team provides strategic insight, financial guidance, and financial performance management across the organization
• Partner with Region, Benefit, and business leaders to elevate financial rigor, influence strategic choices, accelerate P&L performance, and proactively identify and mitigate risks
• Set Board of Directors and Finance Committee agendas; develop and present materials
• Serve as finance advisor to P&L owners and functional leaders
• Provide direction and oversight for financial analyses, models, dashboards, and reporting packages

Director, Finance Business Partners

Analyst

• Perform ongoing synthesis and analysis of health care quality metric performance and other key performance indicators.
• Conduct intermediate to advanced analysis of key health-related metrics and program data to identify trends, forecast performance, and calculate performance targets.
• Develop dashboards and visual assessments of health care quality metric performance and key performance indicators using claims, administrative, and/or program data.
• Use analytic technical skills to assess the effect of key program and policy decisions to meet strategic quality improvement goals.
• Provide data and analysis to leaders to inform strategic recommendations on health care quality.
• Present data in an effective and understandable way and assist others in understanding how data can inform improvement.
• Provide guidance or expertise to other analysts within I&E.
• Provide data and serve as metric experts on projects.
• Effectively communicate complex analyses and data to non-technical audiences, including presenting at internal and external workgroups and committees.
• Participate in scoping and timeline development of data analytic work.
• Collaborate with internal and external stakeholders as it relates to health care data and clinical quality metrics.
• Represent the I&E team in cross-departmental/cross-regional workgroups.
• Serve as subject matter expert (SME) on technical specifications of clinical quality measures; may serve as a resource on key data sets.
• Provide technical and analytic support on the development and distribution of data to internal and external stakeholders.
• Identify professional development opportunities around quality improvement, data, data analysis, and data translation.
• Develop, assess, and implement new metric monitoring and reporting systems.
• Create process documentation for data and metric analytics.
• Provide analytic components of regulatory deliverables and ensure timely submission.
• Serve as quality improvement analytics contact to OHA or CMS for regulatory meetings/deliverables.
• 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.

Quality Improvement Analyst II

Auditor

• Perform and lead a variety of coding-related audits for providers and other entities
• Review medical records to verify that complete and accurate diagnosis codes are captured in claims and retrospective chart review data
• Communicate audit results and recommendations for improvement to providers when needed
• Create and maintain processes for tracking audit results and outcomes of reviews
• Identify, track, analyze and report on any trends revealed in audits
• Develop and maintain centralized policy, process and compliance-related documentation and training resources to support the education of providers and internal stakeholders
• Lead the development of educational materials and process documentation in a variety of mediums
• Actively maintain up-to-date knowledge of coding guidelines and applicable state and federal regulations
• Maintain active coding certification
• Seek out emerging coding best practices
• Serve as subject matter expert regarding correct coding practices
• Collaborate with Risk Adjustment team to create SOPs and contribute to roadmaps for Risk Adjustment Coding initiatives
• Onboard and train new Coding Auditors

Senior Risk Adjustment Coding Auditor

IT Support

• Customer Service and Claims Processing
• Communicate in a professional and respectful manner
• Maintain confidentiality within HIPAA regulations and function on “need to know” principles
• Respond to drug coverage inquiries in an accurate and timely manner to members, members’ representatives, providers, and CareOregon staff
• Educate members, providers, pharmacies, and CareOregon staff about the CareOregon formularies and pharmacy benefit policies
• Document all customer service activities according to organization requirements
• Follow policies and procedures to answer questions from members, providers and CareOregon staff regarding claims processing as it pertains to the CareOregon pharmacy benefits and coverage of drugs under the major medical benefit
• Follow policies and procedures to determine a resolution to pharmacy claims adjudication issues or triage to other CareOregon staff for assistance
• Data Entry and Clerical Support
• Sort incoming faxes and distribute according to assignments
• Maintain files according to unit protocols
• Perform data entry into the claims processing system, document management systems, databases and spreadsheets as assigned.
• Clerical Assistance for pharmacy projects, including, but not limited to distribution of education materials to members, providers or pharmacies, letters & mailings, and reports.
• Prior Authorizations (PA) and Formulary Exceptions
• Verify member’s plan eligibility and applicable benefit for drug coverage
• Review member’s medication and eligibility history, load authorization in claim adjudication platform(s)
• Assist members and providers with the PA, formulary exception and coverage determination process
• Follow policy & procedures to facilitate a resolution for prior authorization, formulary exception and coverage determination requests
• Notify members, providers or providers staff of prior authorization and formulary exception decisions
• Appeals and Grievances
• Explain pharmacy appeal and grievances provisions and process to members, providers and CareOregon staff
• Assist PBS II and PBS Lead with setting up pharmacy benefit appeals and grievances
• Project Coordination
• Minimal project participation

Pharmacy Benefit Specialist I

Procurement

• Performing procurement and contracting activities at an entry level
• Administering procurement and contracting software
• Developing and negotiating routine contracts
• Performing contract administration duties
• Helping to ensure quality control and compliance
• Advising and providing technical guidance to internal staff regarding procurement processes
• Developing and drafting solicitation documents
• Facilitating procurement processes to ensure compliance with procurement policies
• Assisting in technical market research
• Evaluating supplier proposals to ensure all requirements are met
• Reviewing, approving, and processing purchasing requests
• Reviewing, drafting, negotiating, and facilitating execution of business contracts and amendments
• Supporting the organization’s mission, vision, and values
• Performing other duties as needed

Procurement and Contract Analyst I

• Perform Data Warehouse Architecture at an intermediate level
• Focus on design and development of data models and ETL specifications
• Conduct data analysis, system design and architecture
• Propose requirements, standards, and best practices for data modeling
• Conduct product and vendor research, and present recommendations

IS Data Warehouse Architect II

Translator

• Coordinate translation project work of member materials to threshold languages and other languages
• Verify specifications of translation work to be completed; ensure clear and timely communication with vendors
• Track assigned translation projects closely to balance ongoing coordination needs with deadlines
• Monitor translation product quality assurance processes and collaborate with a multidisciplinary team
• Provide suggestions to optimize translation service workflows in support of customer experience
• Update intranet and service sites and respond to policy-related questions as needed

Translation Services Coordinator

• Lead functional administrator tasks for multiple areas within Workday with understanding of cross-functional dependencies
• Interpret needs and develop and guide functional teams on routine to complex business processes and workflows
• Identify and create new calculated fields, rules, validations, alerts, mass operations management (MOM), passive events, custom objects, custom fields, and standard and custom organizations
• Administer reporting intake process; meet with all levels of management to discuss, clarify, interpret, and guide in requests for data
• Maintain data integrity in systems by creating new custom reports or automated alerts to identify and mitigate recurring or critical errors
• Identify risks, configuration options to improve processes, and recommend best practices and mitigations based on Workday functionality
• Develop and oversee technical documentation, such as data dictionaries, glossaries, and procedures for relevant data and reports

Senior Workday Analyst – Finance

Program Manager

• The Regulatory Affairs Program Manager supports the development, oversight, and implementation of regulatory programs
• Provides leadership and expertise across multiple program areas
• Serves as strategic partners to internal departments, facilitating cross-functional enterprise coordination
• Maintains the infrastructure, documentation, and workflows that support regulatory alignment and organizational accountability