Manager, Provider Network Access and Adequacy
Posted on: January 27, 2023
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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
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
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.
Lead, develop and maintain continuous improvement strategies and
best practices to promote network adequacy and access to covered
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
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
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.
Engage PacificSource departments in advancing comprehensive access
to care and network adequacy strategies.
Meet department and company performance and attendance
regulations concerning confidentiality and security of protected
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
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 a Successful Team
Aligning Performance for Success
Driving for Results
Environment: Work inside in a general office setting with
ergonomically configured equipment. Travel is required
approximately 30% of the time.
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
We encourage creativity, innovation, and the pursuit of
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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