Access to Care Program Manager

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Pacific Source 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, sex, sexual orientation, gender identity, national origin, genetic information or age. Pacific Source values the diversity of our community, including those we hire and serve.

We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

The Access to Care Program Manager will oversee and manage all aspects of provider network access for all assigned networks. Responsibilities include development, management and oversight of access to care plans for each network. Manages regular and ad hoc network evaluation and reporting to state agencies. Responsibilities also include engaging, informing, and responding to internal stakeholders and state agencies.

• Manages network access monitoring and reporting to State and/or Federal agencies, including leading report writing and project management . Collaborates closely with and monitors access functions across Provider Network teams, project managers, and cross-departmental subject matter experts.
• Establishes tools and processes necessary to meet all State and Federal reporting and monitoring requirements.
• Maintains full understanding of current State and Federal regulatory requirements related to network management, reporting and provider directory accuracy.
• In consultation with company experts, interprets regulatory requirements for network access and adequacy for cross functional teams.
• Maintains and updates required documentation and policies related to network access and adequacy regulations.
• Responds to regulator inquiries or objections by researching the objection, including the laws cited. Works with a cross functional team to compose and deliver a response.
• Reviews network access reports to create trend analyses and summaries for decision-making purposes including disruption analysis for Pacific Source markets and networks. Assimilates large quantities of simple and moderately complex data into meaningful formats for tracking and status inquires.
• In collaboration with various Provider Network teams and other experts, ensures the accuracy and quality of data related to provider network access and adequacy reporting.
• Interprets and consults on access analyses for Provider Contracting and other company stakeholders, in collaboration with analyst teams.
• Monitors State and Federal sanctions/corrective actions against other payers to ensure Pacific Source avoids similar disapproved practices.
• Monitors contract requirements for adherence to components, tracks and manages deliverables, establishes improvement plans as needed.
• Collaborates with Pacific Source filing teams and content leaders for forms, rates and binders to ensure annual network reports align with those filings.
• Collaborates with Analytic teams to perform analytical reviews and evaluations of healthcare provider networks by analyzing data, contributing to the development of data models, and using business analytical tools to produce data visualizations.
• Develops reports to make recommendations for management consideration regarding issues of potential healthcare provider network access gaps identified through analysis, internal referrals, healthcare providers, and member complaints.
• Creates reports for internal stakeholders, advising of potential and actual access issues. Tracks progress toward resolution.
• Collaborates with reporting team to develop optimal formats, review for quality and accuracy, and communicate both scheduled and ad hoc requests.
• Communicates directly with State agencies or Pacific Source’s internal government relationship owner on Access topics and filings, with direction and guidance of leadership.
• Monitors tracking tools for network adequacy for assigned lines of business, being able to easily show status of contracting efforts/success in obtaining adequate and marketable network.
• Updates Policies and Procedures related to Access reporting and monitoring requirements.
• Leads access to care cross-departmental Access to Care Committee for assigned networks to develop comprehensive regional work plans and mitigation strategies based on regulatory requirements.
• Collaborates to develop and implement Provider Network-focused health equity initiatives aligned with provider workforce development, the health equity Quality Incentive Measure (QIM), and other internal priorities.
• May submit required provider contract or regulatory filings to State agencies per assigned network regulatory requirements, with direction and guidance of leadership.

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