Manager, Network Adequacy Reporting (SQL)

Job Summary:

The Manager, Network Adequacy Reporting is responsible for overseeing the analysis and reporting of the adequacy of the provider networks for CareSource’s numerous products. This role involves ensuring that the networks meet regulatory requirements, that adequacy reports filed with regulators are accurate, and that data on gaps and exceptions are readily available to the Network Development teams. The incumbent will lead a team in conducting comprehensive assessments of network adequacy, identifying potential gaps and data errors, and implementing strategies to optimize network performance and accessibility for CareSource members, and plays a crucial role in ensuring the provider network remains robust, compliant and responsible to the healthcare needs of its members.

Essential Functions:

• Develop and implement processes to monitor key metrics to ensure accuracy of data, process efficiency, compliance with regulatory requirements, and staff performance
• Lead a team of analysts in conducting regular assessments and analyses of network adequacy, identifying gaps and areas for improvement
• Collaborate with internal stakeholders, including network management, operations, and regulatory compliance teams, to address network deficiencies and implement effective strategies for enhancement
• Generate comprehensive reports and presentations on network adequacy metrics, providing insights and recommendations to senior leadership for informed decision-making
• Stay updated on industry trends, regulatory changes, and best practices related to network adequacy, and integrate this knowledge into the organization's network development strategies
• Develop departmental training and evaluation techniques
• Responsible for hiring, training, coaching and developing direct reports including completing performance appraisals and disciplinary actions as needed
• Perform any other job related instructions, as requested

Education and Experience:

• Bachelor's degree in healthcare administration, business administration, public health, or a related field or equivalent years of relevant experience is required
• Minimum of five (5) years of experience in healthcare management, network development, or a related field, with at least two (2) years in a supervisory or leadership role

Competencies, Knowledge and Skills:

• In-depth knowledge of HMO operations, including provider contracting, network development, and compliance management
• Comprehensive understanding of healthcare regulations, accreditation requirements, and network adequacy standards and reporting  for Marketplace, Medicare Advantage and Medicaid lines of business
• Proficiency in data analysis, reporting, and the use of Quest Analytics software for network assessment and reporting
• Proficiency in T/PL-SQL preferred 
• Advanced proficiency in Excel
• Understanding of Cognizant Facets provider data model
• Strong leadership skills with the ability to motivate and guide a team toward achieving organizational goals
• Excellent communication and interpersonal skills, with the ability to collaborate effectively with internal and external stakeholders
• Analytical mindset with the ability to interpret complex data and make data-driven decisions to improve network adequacy
• Strong organizational skills and the ability to manage multiple projects and deadlines simultaneously

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit/stand for long periods of time

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer, including disability and veteran status. We are committed to a diverse and inclusive work environment.