Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, or Nevada.

Job Summary

This position is responsible for operational oversight of the Member Engagement Operational Programs and supervising the day-to-day operations of the member incentives and engagement staff. Programs include organization-wide initiatives to improve participation in preventative care services, engagement in wellness plans and achievement of health goals through member incentives, education, and high-quality engagement. Responsibilities include coordination of these programs across regions, member outreach planning and administration, compliance review, program evaluation, incorporation of member feedback and implementation of best practices.

Essential Responsibilities

Operational and Program Oversight

• Assist in the ongoing development of member engagement program guidelines that meet state and federal laws and regulations by assisting in the interpretation of regulations, documenting the guidelines, and ensuring compliance.
• Stabilize member engagement operational program infrastructure by partnering with Information Systems teams to establish or enhance systems and refine processes.
• Partner to develop and administer the incentive, smoking cessation and additional operational programs, initiatives, and campaigns to improve member engagement.
• Implement member engagement initiatives at the operational and member levels while ensuring programs meet cost, utilization, revenue, and quality improvement targets.
• Ensure that the incentive and engagement programs meet performance goals and regulatory deliverables.
• Identify process improvement opportunities and participate in their development and implementation.
• Develop, utilize, and regularly monitor measures/metrics to evaluate and improve the program’s effectiveness and efficiency of processes.
• Partner with the data analytics team to analyze program data and identify opportunities to improve member health outcomes.
• Stay informed of the progress towards meeting cost and utilization targets, CCO incentive metrics, STARS clinical quality metrics and various performance improvement projects.
• Lead business units in meeting established goals and objectives with well-defined work plans.

Interdepartmental Collaboration

• Collaborate with regional leads and medical directors to develop guidelines for the member engagement and incentive programs’ regional variations.
• Identify and promote best practices and appropriate member engagement and incentives strategies based on targeted population and activities.
• Collaborate with regional staff to customize materials for member outreach and engagement.
• Train CareOregon staff on incentive program system workflow, timelines, and deadlines.
• Coordinate with provider support teams to ensure that clinical partners are aware of and have access to member engagement and incentive program information and materials.
• Coordinate with customer service teams to provide back-up support for the processing of member engagement and incentive requests in accordance with program guidelines and compliance with regulations.
• Coordinate with Mail Room team and fulfillment vendor to improve processes, improve accuracy of address data and reduce quantity of undeliverable letters and materials.

Member Outreach and Engagement Coordination

• Establish and manage the program work plan including the identification of member engagement activities to be incentivized, the schedule for generating lists of eligible patients, and turn-around times for fulfillment and creation of outreach materials that engage priority populations.
• Work with fulfillment vendors to ensure that member engagement and incentive program activities provide value to members and meet state and federal requirements.
• Coordinate member engagement vendors and oversees vendor performance.
• Provide education and input into the design of marketing materials and rewards that will support and motivate behavior change specifically within priority populations.
• Take ongoing steps to improve the accuracy of member eligibility lists and associated demographic data.
• Develop a tracking system to document the reasons for ineligibility and intervention activities and identify opportunities to improve processes.
• Track program costs and monitor against budgeted allocations.
• Provide ongoing communication with CareOregon teams about the program effectiveness and how performance can be improved.

Quality Assurance and Program Evaluation

• Oversee quality assurance activities and review metrics regarding the accuracy of mailing lists and the turn-around times for fulfillment by return channel (e.g., mail, fax, phone, portal).
• Provide reporting to CareOregon stakeholders regarding the mailing program response rate, demographic reach, effectiveness, and cost.
• Participate in on-going quantitative and qualitative data collection, assessment, and process improvement.

Employee Supervision

• Supervise team and recommend team direction and goals in alignment with the organizational mission, vision, and values.
• Identify work and staffing needs to meet work expectations; recruit and hire, using an equity, diversity, and inclusion lens.
• Plan, organize, schedule, and monitor work; ensure employees have information and resources to meet job expectations.
• Lead the development, communication, and oversight of team and individual goals; ensure goals, expectations, and standards are clearly understood by staff.
• Train, supervise, motivate, and coach employees; provide support toward employee development.
• Incorporate guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, and decision making.
• Ensure team adheres to department and organizational standards, policies, and procedures.
• Evaluate employee performance and provide regular feedback to support success; recognize strong performance and address performance gaps and accountability (corrective action).
• Perform supervisory tasks in collaboration with Human Resources as needed.

Organizational Responsibilities

• 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.

Experience and/or Education

Required

• Minimum 3 years’ related work experience in areas such as incentives, outreach, engagement, and program or data coordination activities
• Minimum 1 year experience in a supervisory, lead position or completion of CareOregon’s Aspiring Leaders Program; lead roles should include regular assistance to a manager or supervisor in staff hiring, coaching, performance evaluation, and other supervisory tasks

Preferred

• More than 1 year of experience in a supervisory or lead position
• Experience working with health care clinics and/or health insurance
• Program administration and evaluation experience

Knowledge, Skills and Abilities Required

Knowledge

• Understanding of health care incentive program goals, needs, and benefits
• Knowledge of continuous improvement and project management processes
• Knowledge of QNXT, CIM, and Salesforce or similar systems/applications
• Knowledge of the health plan regulatory requirements of Medicaid, Medicare, and managed care
• Knowledge of quantitative program evaluation methodologies and analysis strategies

Skills and Abilities

• Proficiency in Microsoft Office applications including Outlook, Word, Excel, and PowerPoint
• Strong ability to use Excel for data analysis
• Strong ability to use large database for reporting functions
• Highly effective oral and written communication skills
• Strong interpersonal and customer service skills
• Strong attention to detail, organization, and time management skills
• Strong ability to take the initiative and work independently
• Ability to work effectively with diverse individuals and groups
• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to hear and speak clearly for at least 3-6 hours/day

Working Conditions

Work Environment(s): Indoor/Office Community Facilities/Security Outdoor Exposure

Member/Patient Facing: No Telephonic In Person

Hazards: May include, but not limited to, physical and ergonomic hazards.

Equipment: General office equipment

Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used.

#Li-Remote

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment

Veterans are strongly encouraged to apply.

Equal opportunity employer. This company considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.