Corporate Director of Network Adequacy

Role Overview

The Director of Network Adequacy leads the strategic integration and utilization of provider network adequacy, availability, and access data to drive network optimization and improvement. Oversee a team responsible for delivering analysis and reporting that ensures both existing and emerging markets meet geographic access and availability standards in alignment with state contract requirements. Leverages internal and external data sources to identify network gaps and collaborates with the network management team to implement effective remediation strategies.

• Remote - Associate can be located anywhere in the United States.

• Develop and execute business intelligence requirements to manage and validate provider information and ensure data integrity in Facets and Market Data Libraries across the contracting continuum Request for Proposal (RFPs), new markets, new products, market expansions, and re-procurements.
• Design, implement, and document business and reporting processes, programs, policies, and procedures to support transition to market plan operations and meet regulatory reporting requirements.
• Model and drive network development opportunities throughout the contracting lifecycle to address network gaps, implement remediation plans, and support alternative delivery systems while ensuring regulatory and contractual compliance.
• Interpret and apply access and adequacy standards for growth and existing markets in compliance with state and federal contracts, configuration requirements, and reporting obligations.
• Analyze and interpret network adequacy data by collecting, sorting, and evaluating information, blending business and network expertise with strong analytical skills.
• Collaborate across functional areas to identify issues, communicate with executives, and develop strategic action plans related to adequacy, geographic access, network development, and business intelligence. Key partners include Network Management, Provider Enrollment, Market Entry, New Business Development/Growth Markets, and IS stakeholders.

• 10 plus years of relevant experience in healthcare networks, analytics, business intelligence, market development, or related fields
• Proven ability to lead teams, manage complex datasets, and interpret regulatory requirements

• Excellent written and oral presentation/communication skills
• Experience working in matrixed environments
• Effective leadership and analytical skills
• Ability to work collaboratively with internal and external stakeholders