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Manager, Provider Network Access and Adequacy

Company: PacificSource
Location: Portland
Posted on: January 27, 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.


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 requirementsMaintain 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.

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 job description 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.

Keywords: PacificSource, Portland , Manager, Provider Network Access and Adequacy, Executive , Portland, Oregon

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