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Network Strategy Specialist II

Job in Portland - Multnomah County - OR Oregon - USA , 97228
Company: ODS Companies
Contract position
Listed on 2021-02-24
Job specializations:
  • Management
  • Business
Job Description & How to Apply Below
Let's do great things, together

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.

Moda Health is seeking a Network Strategy Specialist who coordinates and completes complex network adequacy analyses related to strategic provider contracting initiatives and network design, in both existing and expansion service areas. Work collaboratively with different teams within the organization in order to achieve both organizational goals and regulatory entity requirements related to provider network.Coordinates and completes complex network adequacy analyses related to strategic provider contracting initiatives and network design, in both existing and expansion service areas. Work collaboratively with different teams within the organization in order to achieve both organizational goals and regulatory entity requirements related to provider network.

Primary Functions:

1. Assist in incorporation of organizational strategy and regulatory requirements to guide design of new or existing provider networks to support customer needs.

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

3. Assists in creation of RFP responses and requirements.

4. Completes complex network adequacy analyses to support provider terminations, Provider Contracting Committee initiatives, Cost saving initiatives, and strategic network design.

5. Evaluates and monitors Network Adequacy compliance with NCQA, CMS, state and internal requirements.

6. Completes Qualified Health Plan Network Filings in existing service areas.

7. Oversee and support provider network initiatives such as Provider Directory Accuracy Project.

8. Supports and completes network adequacy and recruitment analyses related to service area expansions across all lines of business.

9. Support sales team goals through the creation of tools to analyze and communicate Moda's competitive position related to provider networks.

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

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

12. Represents Medical Provider Relations at key internal, and external as needed, meetings and present initiatives to various committees.

13. Provide support to Provider Network Strategy Coordinator I.

14. Other duties as assigned.

Are you ready to be a betterist?

If you're ready to make a difference that matters, we want to hear from you. Because it's time to discover what's possible.

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.
Position Requirements
Less than 1 Year work experience
 
 
 
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