Jobs at CareOregon

Lead large-scale projects, programs, and process improvements using project/program management, change management, and Lean principles. Develop plans, manage stakeholders and resources, monitor status, budgets and compliance, deliver training, mentor staff, and ensure successful implementation and documentation across health plan systems.

Lead large, complex technology-focused projects using project management and LEAN principles across the full lifecycle. Scope, plan, manage implementation, drive stakeholder consensus, ensure compliance, manage budgets, apply change management, maintain documentation, and support post-implementation evaluation for enterprise-wide initiatives.

Administers the healthcare fraud, waste, and abuse program for Medicare and Medicaid operations. Conducts investigations, audits, corrective actions, risk assessments, and compliance reporting; maintains case documentation; responds to regulatory requests; recommends policy improvements; supports training and provider education; and analyzes data for internal and external stakeholders.

Provides administrative support for a department by preparing correspondence, managing spreadsheets, invoices, expenses, records, supplies, meetings, presentations, minutes, schedules, and travel arrangements. Responds to inquiries, coordinates stakeholders, maintains effective relationships, supports process improvements, and meets departmental goals. Requires strong organization, communication, customer service, judgment, attention to detail, and proficiency with Microsoft Office. The role is office-based three days per week.

Partners with business units and leaders on HR strategy, employee relations, performance management, workforce planning, succession planning, recruiting, onboarding, training, and organizational development. Independently investigates and resolves complex employee relations matters, interprets policies and employment laws, coaches managers, analyzes workforce trends, and supports leadership development and retention initiatives.

Investigates and audits healthcare claims to identify overpayments, execute recovery strategies, and improve payment integrity. Reviews CMS and RAC topics, validates vendor recovery recommendations, researches regulations and billing guidelines, documents root causes, prepares provider notifications, processes claims adjustments, resolves disputes, and supports testing. The role collaborates with clinical, finance, claims, contracting, configuration, provider relations, vendors, and other internal partners while meeting productivity, quality, and savings goals.

Conduct and document fraud, waste, and abuse (FWA) investigations and audits; prepare reports and corrective action recommendations; maintain FWA documentation and reporting; support policy, training, risk assessment, and regulatory requests; analyze and present data to internal and external stakeholders.

Leads and grows a customer-centered Finance organization overseeing accounting, reporting, planning, actuarial analysis, rate development, risk adjustment, revenue, and procurement. Provides strategic financial leadership for Medicaid and Medicare operations, budgeting, forecasting, regulatory compliance, investments, partnerships, and organizational planning. Advises executive leadership, manages stakeholder relationships, sponsors key initiatives, and develops high-performing teams through hiring, coaching, performance management, and continuous improvement.

Lead analytics and quality improvement work for a regional payer: perform complex data analysis, build dashboards (Tableau), guide regulatory reporting, lead projects and analysts, provide QI technical assistance, and coordinate cross-departmental initiatives to meet clinical performance metrics and compliance.

Perform QA reviews of HRSN/rent-assistance benefit allocations, validate documentation and calculations, analyze trends, prepare reports for leadership and OHA, support audits and corrective actions, provide data entry and accounting support, maintain records, and develop training and process improvements. Use Office, SharePoint, Workday, and Unite Us; collaborate with cross-functional teams to ensure compliance and program quality.

Manage actuarial analysis for financial reporting, including IBNR and PDR estimates, trend forecasting, cost/utilization modeling, ROI evaluation, regulatory reporting, and leading a team. Partner with finance and business leaders to communicate results, drive data-driven decisions, and ensure timely regulatory submissions.

Translate English member materials into culturally appropriate Spanish using CAT tools, ensure accuracy, style, and reading-level compliance, proofread vendor work, collaborate with creative teams, and meet deadlines to support language access for LEP members.

Lead enterprise provider data management and credentialing operations for Medicaid and Medicare lines, ensuring compliant, accurate provider data, optimized systems, strategic network development, resource and budget management, process improvement, and team leadership to meet regulatory and organizational objectives.