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.

​​​​​​Job Summary:

Manages all aspects of pharmacy operations including business implementation processes to help drive the growth of the business. Manages and maintains Medicare and Medicaid pharmacy programs specific to CMS standards. Manages the operational prior authorization (PA) workflows, coordinates with key business partners, and is responsible for driving operational efficiency. Provides leadership to team and business partners to support organization’s ability to provide innovative programs and quality service to our customers.  Effectively manages department by coaching and developing supervisors, leads, and staff.  Establishes strong working relationships with core business partners and management in other key areas of the organization to assure seamless delivery of products and services. 

This is a FT hybrid position based in Portland, Oregon. 

Pay Range

$77,364.14 - $96,705.18 ​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.

https://j.brt.mv/jb.do?reqGK=27755244&refresh=true


Benefits:

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

Primary Functions:​​​​

• Manages all operational activities within the Pharmacy team for Government and non-Government lines of business.
• Manages prior authorization (PA) operations teams for all lines of business.
• Oversees all CMS reporting and audit requirements, including data validation, program audits, and mock audits.
• Ensures compliance with CMS standards and other Federal and State regulations relating to pharmacy benefit management and services.
• Works collaboratively with Director, Pharmacy Operations to support all audits related to Commercial business and business governed by the Affordable Care Act (ACA).
• Manages annual Medicare and ACA bids and related filings.
• Supports annual groups renewals and requests for proposal, as needed.
• Oversees day-to-day relationship with and manages performance of key pharmacy vendors, including electronic prior authorization (ePA) and pharmacy benefit manager (PBM) partners.
• Ensures department standards, goals, and objectives are achieved by tracking key performance indicators, monitoring team performance, and providing leadership and coaching to team members.
• Works cooperatively with management from key areas (e.g. Clinical Pharmacy, Benefits, Customer Service, Regulatory & Compliance, Appeals, Membership Accounting) to assure the integrity of service provided to existing groups and to work collective to implement new business in a timely and accurate manner.
• Develops staff to communicate pro-actively to appropriate areas within the corporation for their areas of responsibility. Responsible for annual performance appraisals of direct reports.
• Develops and manages overall vision for the business units, tied directly to Moda’s Strategic Plan.
• Provides direction to supervisory staff and team regarding the ongoing development of training, documentation, and audit programs, with emphasis on results that can be reported corporately.
• Identifies areas for process improvement, both within the department and cross-functionally, leading project teams as needed in process improvement endeavors.
• Assures that staff in the department are being developed at an appropriate rate, and that the appropriate resources are available to them.
• Provides support in preparing and managing the annual budget for the department.
• Evaluates and manages staffing assignments as needed, within vastly changing conditions, to maximize productivity throughout the month.
• Emulates and coaches’ staff in creative problem solving, employing “outside the box” thinking to identify the most efficient use of the resources (system and human) available.
• Assures that all staff within the department are held accountable for their contributions.
• Other duties as assigned

Required Skills & Experience:

• Bachelor’s degree, or equivalent work experience in health plan operations.
• 3-5 years supervisory experience, with demonstrated ability to motivate staff to the highest outcomes.
• Certified Pharmacy Technician (CPhT) license preferred.
• Leadership experience in multiple functional health plan areas including claims processing, pharmacy benefits, and prior authorization. 
• Proficiency in leading teams and managing large scale projects.
• Proficiency with Microsoft Office applications.
• Ability to learn multiple new systems, including PBM and ePA systems.
• Ability to establish credibility, instilling confidence in Moda’s ability to deliver the highest quality products on time.
• Ability to quickly identify the processes, procedures and resources needed to resolve issues.
• Ability to build effective relationships with all personnel and stakeholders in the company as well as with business associates across all lines of business.
• Ability to work proactively and collaboratively with internal users and our business partners to initiate and execute process improvements.
• Demonstrate strong, effective, and diplomatic interpersonal skills with employees of all levels.
• Demonstrate clearly visible leadership talents and commitment to teamwork and our customers.
• Ability to creatively solve problems, negotiate and influence decisions as appropriate
• Ability to plan, organize and prioritize departmental assignments to ensure established guidelines, timelines and quality goals are met.
• Ability to work cross-functionally to build new and/or re-engineer existing processes for maximum efficiency and quality outcomes.
• Possess high level of energy, sense of urgency, creativity and decisiveness coupled with the ability/willingness to work hard and effectively under pressure.
• Ability to work independently, with minimal supervision
• Maintain confidentiality and project a professional business image.

Contact with Others & Working Conditions: 

• Office environment with remote work flexibility. 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 requirements when needed.
• Internal with all levels of staff and departments, including subsidiaries. Externally with business partners and vendors including PBM, ePA vendor, agents, groups, providers, and members.

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