Job Details

Ancillary Network Manager

Moda Health, Portland, OR

Job - Health

Close Date: 09/20/2019

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 Health is seeking an Ancillary Network Manager. The Ancillary Network Manager will be responsible for developing and maintaining a network of ancillary, behavioral health, alternative care and vison providers to meet the needs of Moda members in all Moda service areas, maintain high quality, and support financial sustainability.  In addition, this individual will design and execute reimbursement strategies to achieve organizational goals.  The Ancillary Network Manager will provide direct management of a team of Provider Relations Representatives and Contractors.  The role is responsible for recruiting, work assignments, professional development, and performance management for the teams. Total Number of Direct Reports is 3-7.

Primary Functions:
01.    Develop and execute contracting strategies for ancillary, behavioral health, and alternative care contracts that support the clinical, programmatic, and financial goals of the organization.
02.    Work with leadership and contracting team to strategize and prioritize provider recruitment and re-contracting activities in compliance with regulatory and corporate requirements.
03.    Develop and maintain work flows, processes, performance metrics, and management tools to foster an environment of professionalism and performance excellence.
04.    Provide coaching, mentoring, support, and oversight in the contracting and contract negotiation process, drawing upon experience and subject matter expertise.
05.    Collaborates with and builds strong partnerships across the organization to align network recruitment and management activities with membership and clinical care goals, regulatory compliance, and other organizational priorities.
06.    Negotiate complex contracts with ancillary providers.

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.

Required Skills:
• Bachelor's degree in health care administration or related field, or equivalent experience.
• Minimum 3 years experience as a Senior Contractor in the managed care, benefits, or health insurance industry required.
• Expert level knowledge of physician, hospital, and ancillary provider contracts and reimbursement mechanisms, including risk mechanisms, capitation, and alternate payment models.
• Ability to deliver results consistently by successfully planning and organizing goals. Ability to establish and monitor meaningful metrics
• Highly skilled in issue resolution.
• Must be interpersonally savvy by relating well to people at all levels in the organization by building rapport and remaining diplomatic. Can easily maneuver through complex political situations effectively.
• Ability to accurately prioritize and organize short-term and long-term responsibilities in response to changing demands.
• Ability to hold a team accountable and take corrective action when appropriate.
• Substantive knowledge of managed care industry including compliance.
• Solid knowledge of ICD-9, MSDRG and CPT Codes.
• Strong written, verbal and presentation communication skills and effective relationship management experience a must.
• Attention to detail; ability to juggle multiple priorities and deadlines; strong follow through.
• Ability to travel up to 15% of the time.

Complete details: