44 Moda Health Medical Coder Jobs Hiring Near You

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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
The Manager of Clinical Pharmacy role oversees and maintains clinical aspects of Commercial, Medicare, and Medicaid pharmacy-related programs. This position focuses on initiating, supporting, and continuing evidence-based, cost-effective medication utilization strategies and clinical programs, while providing clinical support to internal departments and external customers. This role is supported by two Clinical Pharmacy Supervisors, each responsible for distinct workstreams. One supervisor oversees prior authorization and related functions, while the other leads development of drug monographs for the Pharmacy and Therapeutics Committee, including formulary management and policy development. The Manager of Clinical Pharmacy position is responsible for leading all these key areas of work within our health plan. The ideal candidate resides near or within commuting distance of our Portland, Oregon office to support a hybrid work arrangement, however, remote status will also be considered.

Pay Range
$150,000.00- $200,000.00 annually (depending on experience)
*This role may be classified as hourly (non-exempt) depending on the applicant's location. 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=27778160&refresh=true
Benefits:

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

Required Skills, Experience & Education:

1. Doctor of Pharmacy degree (Pharm.D.) preferred, or Bachelors of Pharmacy degree.
2. Valid Registered Pharmacist (RPh) license in the State of Oregon, or ability to become licensed within 60 days of employment.
3. Success managing a team of pharmacists preferred, or two or more years of supervisory/management experience.
4. Three or more years of managed care experience related to Commercial, Medicare, and/or Medicaid benefit administration. Deep Medicare Part D expertise preferred.
5. Demonstrated ability to lead multiple complex, concurrent projects and initiatives.
6. Demonstrated ability to work with large data sets and experience in identifying and implementing process improvements.
7. Ability to work collaboratively with other departments across the Moda organization.
8. Advanced understanding of managed care pharmacy landscape and the medication use system.
9. Demonstrate a commitment to service, organization values, and professionalism through appropriate conduct and demeanor.
10. Ability to maintain confidentiality and project a professional business image.
11. Regular attendance, dependability, and promptness required. Ability to attend regular meetings in-person and as needed.
12. Proficient with Microsoft Office applications.
13. Post-graduate training (residency and/or fellowship) preferred, although not required.

Primary Functions:

1. Oversight of core clinical pharmacy functions, including, but not limited to formulary management (including Pharmacy & Therapeutics Committee), utilization management, prior authorization, and other clinical pharmacy programs.
2. Provide oversight and ensure compliance with pharmacy law, state and federal regulations, pharmacy business practices, accreditation practices, and other internal organization policies.
3. Manages accessibility, quality, and cost-effectiveness of medication therapy for members and providers.
4. Represent clinical pharmacy in audits, appeals-related hearings, and other formal regulatory review processes.
5. Develop and maintain pharmacy program policies and procedures to ensure compliance with internal and external requirements.
6. Participate as a clinical leader across the operational units to deliver the highest levels of program performance and integrated clinical service to internal and external clients.
7. Serve as the clinical leader and point of contact and collaborate with internal and external partners, clients, and vendors to execute pharmacy management strategies and programs.
8. Represent clinical pharmacy in internal committee meetings and/or cross-functional initiatives ranging from regulatory and compliance to member and provider engagement activities.
9. Oversees the assignment and completion of key clinical pharmacy activities, such as new drug evaluations, medical necessity criteria creation and maintenance, and formulary enhancements.
10. Provide concise, applicable, comprehensive, and timely responses to requests for drug information from members, clients, providers, and internal teams.
11. Manage escalated issues arising from a multitude of sources, such as members, providers, vendors, clients, and internal teams or departments, such as customer service or appeals and grievances.
12. In collaboration with other department leaders, oversee the quality of the clinical projects, tasks, and deliverables through productivity reporting and quality assurance processes.
13. Review, analyze, evaluate, and interpret scientific and medical journals, financial reports, and legal documents to provide recommendations or guidance to other stakeholders.
14. Lead and complete significant projects as assigned to meet team and/or business objectives.
15. Provide leadership, coaching, performance management, and professional development for clinical pharmacy staff and supervisors.
16. Provide oversight and leadership to quality and population health clinical programs.
17. Support Director, Clinical Pharmacy and other department leaders on special projects and initiatives that support the current and future needs of the organization and teams.
18. Performs 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 needs.

• Interdepartmental work within the company including Actuary & Analytics, Customer Service, Healthcare Services, Legal, Marketing, Medicare/Medicaid, Membership Accounting, Quality Management, Policy, Regulatory & Compliance, Sales & Account Services, and Underwriting. External work outside of the company with Pharmacy Benefit Manager (PBM), medical management organizations, CMS, pharmaceutical manufacturers, consultants/producers, auditors, business partners/vendors, clients, prospective clients, physicians and other prescribing providers, and pharmacists.

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.