Provider Relations Representative, Oral Health

PROVIDER RELATIONS REPRESENTATIVE, ORAL HEALTH

HYBRID, must be able to travel to 3031 NE

STEPHENS ST. ROSEBURG, OR 97470

Employment Type:

Full-Time, Exempt About Umpqua Health At Umpqua Health, we're more than a healthcare organization—we're a community-driven Coordinated Care Organization (CCO) dedicated to improving the health and well-being of individuals and families throughout Douglas County, Oregon. We provide integrated, whole-person care through primary care, specialty care, behavioral health services, and care coordination. Our collaborative approach ensures members receive high-quality, personalized care while supporting a stronger, healthier community.

POSITION PURPOSE

The Provider Relations Representative

• Oral Health serves as the primary liaison between Umpqua Health and its delegated dental care network entity.

This role provides operational oversight of the delegated contract, ensures compliance with contractual requirements, monitors performance metrics, and assists in the implementation of oral health programs. The position requires strong knowledge of dental care delivery systems, managed care principles, and the ability to collaborate with internal teams and external partners to improve access, quality, and member experience.

ESSENTIAL JOB RESPONSIBILITIES

Oversee the dental care network managed by the delegated entity, ensuring compliance with contractual obligations and performance standards. Monitor and report on key metrics such as access, utilization, quality measures, and member satisfaction. Conduct regular reviews of delegated entity operations to ensure adherence to Umpqua Health policies and regulatory requirements. Ensure delegated entity meets all contractual requirements, including reporting, credentialing, and quality benchmarks. Collaborate with internal teams to address gaps in performance and implement corrective action plans when necessary. Maintain accurate documentation of oversight activities and prepare reports for leadership and regulatory agencies. Serve as a resource for oral health providers within the network, addressing inquiries and resolving issues related to claims, credentialing, and operational processes. Deliver training and education to providers on Umpqua Health initiatives, compliance standards, and oral health program requirements. Assist in the development and implementation of oral health programs aimed at improving preventive care, member engagement, and overall health outcomes. Support initiatives that integrate oral health with primary care and behavioral health services. Partner with internal departments such as Compliance, Quality, and Network Development to ensure alignment of oral health strategies with organizational goals. Participate in meetings with delegated entity leadership to review performance and discuss improvement opportunities.

CHALLENGES

Working with a variety of personalities, maintaining a consistent and fair communication style. Satisfying the needs of a fast-paced and challenging company.

MINIMUM QUALIFICATIONS

Bachelor's degree in healthcare administration, Business, Public Health, Communications, or a related field Minimum of 3 years of experience as a Provider Relations Representative, Network Manager, or similar role within a Medicaid MCO or dental benefits administrator Minimum of 5 years of hands-on experience working with dental providers (e.g., solo practices, group practices, or clinics serving Medicaid populations), including dental practice management, multi-site operations, or provider outreach Strong knowledge of Medicaid Managed Care principles, including provider contracting, dental claims and billing processes (CDT codes), prior authorization, and regulatory compliance standards (e.g., NCQA, HEDIS, Dental Quality Alliance measures) Familiarity with Oregon's Coordinated Care Organization (CCO) model and Oregon Health Plan (OHP) dental benefits Proven ability to conduct provider education, training sessions, site visits, and resolve issues such as claims disputes, policy questions, and billing support Strong communication and relationship-building skills Strong analytical and problem-solving abilities, including monitoring performance metrics and compliance Proficiency in Microsoft Office Suite and ability to learn provider systems Ability to manage multiple priorities, work independently, and meet deadlines in a field-based environment Ability to interpret and enforce contractual requirements and regulatory standards Ability to collaborate effectively with internal teams and external partners Able to travel on-site

PREFERRED QUALIFICATIONS

Dental-related certifications Medicaid-specific training Experience with value-based care models for oral health Experience with delegated network oversight Experience supporting oral health integration initiatives (e.g., prenatal or pediatric coordination) Demonstrated experience working with diverse and rural provider populations

SCHEDULE

Monday through Friday

• 8:00am
• 5:00pm ; standard business hours with flexibility to meet service timelines. SALARY Wage Band 16: $59,585
• $68,525 BENEFITS Salary is dependent on skills, experience, and education Generous benefits package including vacation PTO, sick leave, federal holidays, and birthday leave Medical, dental, and vision insurance 401(k) with company match (fully vested immediately) Company-sponsored life insurance and additional benefits Fitness reimbursement program Tuition reimbursement and more Why Umpqua Health?

We are committed to advancing health equity by collaborating across communities, addressing systemic barriers, and ensuring fair access to care and resources. At Umpqua Health, every team member plays a vital role in making a meaningful impact, empowering healthier lives and strengthening the communities we serve. Inclusive Culture We foster a respectful, inclusive environment where employees feel valued, supported, and empowered. Growth & Development We support ongoing learning through mentorship, clear career pathways, and professional development opportunities. Work/Life Balance We promote flexibility and well-being so employees can thrive both professionally and personally. Equal Opportunity Umpqua Health is an equal opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and the needs of the business. Our dedication to fairness and equality extends to all aspects of employment, including hiring, training, promotion, and compensation, without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law. RoOJDIaSpj