Access to Care Program Manager

PacificSource Health Plans•Bend, OR

1d•$72,444 - $126,777

About The Position

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! 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, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource 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.

Requirements

Minimum of 5 years of experience in healthcare, managed care, public health or community-based organizations
Bachelor’s degree required. Preferred areas of focus: healthcare administration, business, clinical degree, or related. Candidates with an associate’s degree and 2 years of relevant experience, or a high school diploma and 4 years of relevant experience, in addition to the required minimum years of work experience will also be considered
Demonstrated ability using sound professional judgment to determine cadence and content of regulatory reporting and interaction
Advanced analytical, problem-solving skills, and technical writing skills required
Experience with carrying out systems for monitoring health care organization performance with regulations, requirements, and contract stipulations
Experience designing and implementing quality improvement and/or corrective action performance improvement plans or initiatives
Excellent public relations, presentation, and interpersonal skills required
Demonstrated successful communication skills, including public presentation, training, meeting facilitation and collaboration
Demonstrated experience leading and contributing to cross functional teams to initiate and manage work
Problem solve, develop and execute plans, and complete work requirements
Maintain 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
Accountability
Collaboration
Communication (written/verbal)
Flexibility
Listening (active)
Organizational skills/Planning and Organization
Problem Solving
Teamwork
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

Nice To Haves

Experience with government-funded health care programs (Medicaid and Medicare) and managed care health plans strongly preferred for success in this role
Experience directly working with Insurance Commissioner Offices is desired
Master’s degree preferred

Responsibilities

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 PacificSource 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 PacificSource avoids similar disapproved practices
Monitors contract requirements for adherence to components, tracks and manages deliverables, establishes improvement plans as needed
Collaborates with PacificSource 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 PacificSource’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
Facilitates and actively participates in Access to Care Workgroups
Meets department and company performance and attendance expectations
Follows the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information
Performs other duties as assigned