Job Description

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

This position provides direction and oversight for a portfolio of projects, including performance metrics, coordination of cross functional activities and responsibilities. This role also plans and manages project activities and tasks related to a portfolio of Healthcare Services operations/process improvement projects, i nitiates, develops and evaluates project work plans and manages project tasks and deliverables.   Other activities and responsibilities including, identification and documentation of existing business processes, identification of stakeholders, resources, and accountabilities, determination of project business requirements in coordination with other stakeholders. This is a role for someone who thrives working on cross-functional/multi-disciplinary projects. This position will serve as a Subject Matter Expert (SME) for multiple business and operational functions within the Population Health and Quality Department. The role will require analyzing large amounts of quantitative and qualitative data, drawing conclusions, making recommendations and driving projects to successful conclusions. Hybrid in Portland, OR or fully remote if applicant resides 40+ miles outside of Portland.

Pay Range

$64,394.27 - $80,498.01 annually (depending on experience)

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.

Benefits :

• Medical, Dental, Vision, Pharmacy, Life, & Disability
• 401K- Matching
• FSA
• Employee Assistance Program
• PTO and Company Paid Holidays

Required Skills, Experience & Education:

1. Bachelor degree in Business Administration, Health Services Administration, or related field, required. Masters preferred.
2. 5+ years of business experience in project management and/or project coordination roles or equivalent.
3. Strong verbal, written, and interpersonal communication skills.
4. Knowledge of health insurance business as it relates to provider and vendor contracts, marketing, processing of claims, handling of billings, customer service, and other related information.
5. Ability to work well under pressure, work with frequent interruptions, and shifting priorities.
6. Ability to maintain confidentiality and project a professional business image.

 

Primary Functions :

1. Identify, size and prioritize key initiatives. Define, scope, plan, communicate and execute assigned projects.
2. Manage projects associated with implementing/operationalizing new programs, policies and/or procedures. Includes end-to-end project oversight, calculating, reconciling and auditing programs and their impact. Report findings and status to all levels of the organization, including executives.
3. Identify opportunities for improved efficiency and/or effectiveness associated with Healthcare Services business objectives. Gather business requirements and assist in Healthcare Services department business process re-engineering.
4. Conduct process analyses to identify and develop improvements. Make recommendations on next steps and manage deliverables.
5. Monitor project compliance with Moda, CMS, QHP, State Specific, and NCQA requirements. Ensure development of supporting P&P and workflow. Consistently monitor for changes to requirements and work with internal stakeholders to implement new requirements.
6. Develop and document policies, procedures, processes and workflows for Population Health and Quality department functions.
7. Work with other department stakeholders to assess upstream and downstream impact of process improvement efforts. Document and communicate changes to standards and workflow processes.
8. Participate in daily and project driven activities relating to the support of Healthcare Services Division
9. Perform other duties as assigned.

 

Working Conditions & Contact with Others

• Office environment with extensive close PC and keyboard work, constant sitting, and phone work. Must be able to navigate multiple screens. Work in excess of 40 hours per week, including evenings and occasional weekends, to meet business need.
• Inside the company with various departments.  Outside the company with various stakeholders.
  

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

Job Tags

Full time, Work at office, Shift work, Afternoon shift,

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