Full 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
Provides oversight of quality assurance and quality improvement activities for Moda Health and ODS/Delta Dental for all product lines. Directs the NCQA and/or URAC accreditation initiatives. Manages the member grievances and appeals programs for all product lines, including delegations and compliance initiatives.
Pay Range
$81,475.80 - $ $101,856.32 annually (depending on experience)
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: Master's degree or equivalent specializing in healthcare field or R.N./clinical degree preferred. 3 - 5 years' experience in continuous quality improvement processes, NCQA, JCAHO or URAC accreditation, HEDIS and CAHPS improvement, or related quality activities. 3 - 5 years' experience in state and federal compliance and regulatory processes. Management and supervisory experience. Data analysis, problem solving, organizational, and detail orientation skills. Strong written, verbal, and interpersonal communication skills. Personal computer proficiency with Microsoft Office – Word, Excel, Access. Ability to come into work on time and daily. Maintains confidentiality and projects a professional business image.
Primary Functions : Ensures department standards, goals, objectives, and results are achieved by training, delegating, coaching, monitoring documentation, maintaining accurate records, and tracking results. Provides training, orientation, performance appraisals, hiring and disciplinary action of the Quality Programs staff. Provides leadership for planning, development, organization, and implementation of quality assurance (QA) and quality improvement (QI) activities for Moda Health and ODS/Delta Dental of Oregon. Establishes effective, collaborative working relationships with other departments where there is shared procedural and policy responsibility. Recommends, coordinates, and reports on Moda Health policy development for quality assurance and quality improvement. Chairs the Medical Quality Improvement Committee. Directs activities to meet state or federally mandated quality review and compliance requirements and standards, including clinical quality improvement programs, consumer experience, satisfaction, and protection, and effective of care initiatives. Directs the resolution of corrective action plans resulting from onsite or remote audits of the Moda Health or ODS/Delta Dental quality assurance or compliance program by state and federal regulatory agencies, such as the Oregon Health Authority, state insurance divisions, accrediting entities and the Centers for Medicare and Medicaid Services. 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. Internally with all levels of executives, management and staff and management across department lines. Externally with vendors, contractors, accreditation agencies, healthcare organizations, state insurance divisions, public health agencies, group administrators, consultants, members, providers.
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 Daniel McGinnis via our email.
