Jobs at Umpqua Health

Evaluate clinical service requests, perform prior authorizations, conduct clinical assessments, coordinate care transitions, support discharge planning and quality audits, and ensure regulatory compliance while collaborating with interdisciplinary teams and community providers.

Lead data-driven pricing, network strategy, and contract analytics to optimize provider networks and reduce cost of care. Build predictive models, maintain data integrity, create dashboards and reports, support contract valuation and negotiation, and present recommendations to leadership.

Design, develop, and maintain full-stack web applications, databases, integrations, and BI/data warehouse solutions for health plan operations. Collaborate with cross-functional teams, optimize SQL Server performance, implement C#/.NET and JavaScript/TypeScript solutions, automate data movement and reporting, ensure security and interoperability (HL7, REST), and provide technical mentorship and operational support.

Coordinate and manage workforce development, student/resident placements, onboarding, compliance tracking (licensure, NHSC/HRSA), training administration, performance review coordination, and workforce reporting. Serve as liaison with educational partners, support learning systems (ADP, Lattice, LMS), and promote employee engagement and continuous improvement across the organization.

Oversee TPA performance, ensure claims and benefits are processed accurately and compliantly, resolve escalated claims, manage provider contract distribution and benefit configurations, lead audits and process improvements, and report performance to leadership.

Serve as primary liaison between Umpqua Health and contracted providers. Build relationships, resolve provider questions (claims, eligibility, authorizations), conduct visits and orientations, track interactions, support onboarding, deliver education, monitor network performance, ensure regulatory and contractual compliance, and specialize in Oral Health, Behavioral Health, or HRSN as assigned.

Coordinate intake, review, processing, and tracking of prior authorization requests. Communicate with providers and members, ensure completeness and timely determinations, maintain regulatory compliance, monitor turnaround times, and support workflow coordination and reporting within Medical Management.