Medical PR Network Strategy Specialist

Job Title

Medical PR Network Strategy Specialist

Duration

Open until filled

Description

Let’s do great things, together!

About ModaFounded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let’s be better together.

Position SummaryCoordinates and completes routine network adequacy analyses related to annual monitoring of existing service areas, as well as routine provider network reporting. Work collaboratively with others in the medical provider relations team in order to achieve department network related goals.This is a FT WFH role.Pay Range$51,510.72 - $64,400.58 ​​​annually*Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.

Please fill out an application on our company page, linked below, to be considered for this position.

https://j.brt.mv/jb.do?reqGK=27741050&refresh=trueBenefits:

• Medical, Dental, Vision, Pharmacy, Life, & Disability

• 401K- Matching

• FSA

• Employee Assistance Program

• PTO and Company Paid Holidays

Required Skills, Experience & Education:

• College degree or equivalent work experience.

• 1-3 years in project management in health care or insurance industry.

• Requires analytical and problem-solving skills.

• Ability to perform research (i.e. research into Moda operations) and support policy recommendations.

• Strong interpersonal communication skills, both oral and written.

• Proficiency in MS office applications.

• Demonstrated ability to work independently and be self-directed, as well as work in a team environment when needed.

• Ability to work well under pressure with competing priorities.

• Strong organizational and time management skills.

• Basic knowledge of health insurance business as it relates to provider contracts, compliance, marketing, claims processing, customer service, etc.

• Maintain confidentiality and project a professional business image.

Primary Functions:

• Coordinates and completes network adequacy responses to meet quality programs and regulatory requirements.

• Evaluates Network Adequacy compliance with NCQA and state reporting.

• Coordination of ongoing monitoring of provider networks in existing service areas, as well as identify opportunities for improvement as needed.

• Administers Provider Relations Quality Programs projects including annual assessments for Medical Quality Improvement Programs – NCQA, CAHPS, and HEDIS.

• Participates in and helps coordinate high value special projects related to corporate initiatives and other relevant duties.

• Assists in coordination of provider recruitment projects related to compliance and strategic build of networks.

• Completes monthly rental network fee reporting and coordinates payment.

• Attends conferences, continued education, and actively participated in the community on an ongoing basis.

• Other duties as assigned.

Together, we can be more. We can be better. ​​​​​​Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training. For more information regarding accommodations please direct your questions to Kristy Nehler and Daniel McGinnis via our humanresources@modahealth.com email.