Network Strategy Specialist I

Let’s do great things, together!

About Moda

Founded 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 Summary

Coordinates 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

$48,900.76 - $61,125.95 salary (depending on experience) This role may be classified as hourly (non-exempt) depending on the applicant's location. 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=27765304&refresh=true

Benefits

• 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

• Coordinate and complete network adequacy responses to meet quality programs and regulatory requirements.
• Evaluate Network Adequacy compliance with NCQA and state reporting.
• Coordination of ongoing monitoring of provider networks in existing service areas, as well as identifying opportunities for improvement as needed.
• Administer Provider Relations Quality Programs projects including annual assessments for Medical Quality Improvement Programs – NCQA, CAHPS, and HEDIS.
• Participate in and help coordinate high value special projects related to corporate initiatives and other relevant duties.
• Assist in coordination of provider recruitment projects related to compliance and strategic build of networks.
• Complete monthly rental network fee reporting and coordinates payment.
• Attend conferences, continued education, and actively participated in the community on an ongoing basis.
• Perform other duties as assigned.
  
  

Working Conditions & Contact With Others

• Office environment with extensive close PC and keyboard use, constant sitting, and frequent phone communication. Must be able to navigate multiple computer screens. A reliable, high-speed, hard-wired internet connection required to support remote or hybrid work. Must be comfortable being on camera for virtual training and meetings. Work in excess of standard workweek, including evenings and occasional weekends, to meet business need.
• Internally with all levels of staff and management among multiple departments. Externally with providers, provider clinic staff, vendor, contractors, third party technical support, and consultants.
  
  

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 & Danielle Baker via our humanresources@modahealth.com email.