Manager, Provider Network Access and Adequacy
Company: myGwork
Location: Portland
Posted on: January 26, 2023
Job Description:
Looking for a way to make an impact and help people? Join
PacificSource and help our members access quality, affordable care!
PacificSource is an equal opportunity employer. All qualified
applicants will receive consideration for employment without regard
to status as a protected veteran or a qualified individual with a
disability, or other protected status, such as race, religion,
color, national origin, sex, sexual orientation, gender identity or
age. Diversity and Inclusion: PacificSource values the diversity of
the people we hire and serve. We are committed to creating a
diverse environment and fostering a workplace in which individual
differences are appreciated, respected and responded to in ways
that fully develop and utilize each person's talents and strengths.
Position Overview: This position is accountable for developing the
strategies and long-term vision for developing maintaining an
adequate network and comprehensive member access to covered
services across PacificSource lines of business, and reporting on
network adequacy and access accurately and in a timely manner to
Federal and State entities. The role is directly responsible for
the implementation and oversight of PacificSource's access and
adequacy monitoring and reporting across all key geographies and
lines of business. It is also responsible for providing a wide
range of support and critical judgment and decision-making. The
Manager will oversee a team of access and network adequacy analysts
and program managers, and is responsible for the oversight all
access to care and network adequacy regulatory compliance and
reporting across lines of business. As a key contributor to
PacificSource's core strategy of establishing and maintaining
strong provider partnerships and relationships, the Manager is also
responsible for advancing continuous improvement projects to
identify and advance accuracy and improve processes. Essential
Responsibilities:
- Lead, develop and maintain continuous improvement strategies
and best practices to promote network adequacy and access to
covered services.
- Engage in problem-solving initiatives including internal work
teams and engagements with external provider entities, payer
partners, and State and Federal regulators.
- Experience engaging with internal stakeholders and leaders to
interpret regulatory requirements, convey requirements into action
steps, and engage in continuous collaboration with state directors
and Washington Provider Network leadership.
- In collaboration with key business partners, maintain
up-to-date requirements for network adequacy and timely access for
all lines of business.
- Develop and manage policies and procedures related to access to
care, network adequacy among others.
- Oversee network adequacy and timely access monitoring, analysis
and reporting across lines of business.
- Oversee development, implementation, and management of network
adequacy and marketability assessments and action plans for
Medicaid, Commercial, and Medicare lines of business.
- Provides leadership for the development of the annual
OHA-required Delivery Service Network (DSN) Narrative report and
annual Division of Financial Regulation (DFR) report, Washington
AADRs and all annual and monthly network adequacy reports.
- Collaborates closely with Provider Network Programs team,
project managers, and cross-departmental subject matter
experts.
- Leads Provider Network-focused health equity initiatives
aligned with provider workforce development, the health equity
Quality Incentive Measure (QIM), and other internal
priorities.
- Oversees all access-related internal strategic
initiatives.
- Provide leadership, coaching, training and resource support to
analyst and program manager staff related to performance of
required responsibilities.
- Staff and/or support leadership committees, workgroups and
leadership teams to advance continuous improvement.
- Engages and collaborates with Provider Network, Health
Services, Medical Directors, Community Strategy and other
departments to advance comprehensive access to care
strategies.
- Aligns with the Community Health Excellence (CHE) grants
program to advance strategic access to care initiatives.
- Engage and collaborate with PacificSource Provider Network,
Product Teams and other departments to advance comprehensive
network adequacy and marketability strategies. Supporting
Responsibilities:
- Engage PacificSource departments in advancing comprehensive
access to care and network adequacy strategies.
- Meet department and company performance and attendance
expectations.
- Follow the PacificSource privacy policy and HIPAA laws and
regulations concerning confidentiality and security of protected
health information.
- Perform other duties as assigned. SUCCESS PROFILE Work
Experience: Minimum of 5 years' experience in insurance, provider
organization or related area is required. Minimum 2 years' of
experience in program management and staff management required.
Relevant experience in the following areas preferred: Provider
network, network adequacy, access to care, health disparities, data
management, data analysis, regulatory reporting, and continuous
improvement. Education, Certificates, Licenses: Bachelor's degree
required. Master's degree in public health, healthcare
administration, or business administration strongly preferred.
Knowledge: Training and experience in program development and
implementation required. Strong analytical, problem solving, and
technical writing skills required. Excellent public relations,
presentation, and interpersonal skills required. Demonstrated
successful communication skills, including public presentation,
training, and meeting facilitation. Demonstrated knowledge of
access to care, health disparities, and interventions that advance
the delivery of timely services including culturally and
linguistically appropriate care. Experience with network regulatory
standards and compliance strongly preferred. Demonstrated
experience in designing/implementing transformational initiatives
to meet regulatory requirements, engaging internal and community
stakeholders, conducting stakeholder/provider meetings, and leading
and contributing to cross functional teams to initiate work,
problem solve, develop and execute plans, and complete work
requirements . Maintain high level of knowledge of regulatory
requirements, company products, health reform trends at the Federal
and State levels, and the insurance industry. Math skills required
including percentages, ratios, graphing. Demonstrated skills with
the following software: Microsoft Word, PowerPoint, Excel.
Competencies
- Building Trust
- Building a Successful Team
- Aligning Performance for Success
- Building Partnerships
- Customer Focus
- Continuous Improvement
- Decision Making
- Facilitating Change
- Leveraging Diversity
- Driving for Results Environment: Work inside in a general
office setting with ergonomically configured equipment. Travel is
required approximately 30% of the time. Our Values We live and
breathe our values. In fact, our culture is driven by these seven
core values which guide us in how we do business:
- We are committed to doing the right thing.
- We are one team working toward a common goal.
- We are each responsible for customer service.
- We practice open communication at all levels of the company to
foster individual, team and company growth.
- We actively participate in efforts to improve our many
communities-internally and externally.
- We actively work to advance social justice, equity, diversity
and inclusion in our workplace, the healthcare system and
community.
- We encourage creativity, innovation, and the pursuit of
excellence. Physical Requirements: Stoop and bend. Sit and/or stand
for extended periods of time while performing core job functions.
Repetitive motions to include typing, sorting and filing. Light
lifting and carrying of files and business materials. Ability to
read and comprehend both written and spoken English. Communicate
clearly and effectively. Disclaimer: This indicates the general
nature and level of work performed by employees within this
position and is subject to change. It is not designed to contain or
be interpreted as a comprehensive list of all duties,
responsibilities, and qualifications required of employees assigned
to this position. Employment remains AT-WILL at all times. This
employer is a corporate member of
myGwork - LGBTQ+ professionals, the business community for LGBTQ+
professionals,
students, inclusive employers & anyone who believes in workplace
equality.
Keywords: myGwork, Portland , Manager, Provider Network Access and Adequacy, Executive , Portland, Oregon
Didn't find what you're looking for? Search again!
Loading more jobs...