Health Plan Network Adequacy Analyst III

CareSource•Las Vegas, NV

2d•Onsite

About The Position

The Health Plan Network Adequacy Analyst III reviews and analyzes the effectiveness and efficiency of existing market operation processes and systems, ensures compliance of State and Federal Network Adequacy Standards, and participates in development of solutions to improve or further leverage these functions.

Requirements

Bachelor’s degree in Healthcare, Health Administration, Public Health, Business, Finance, Economics or related field or equivalent years of relevant work experience is required
Minimum of five (5) years of experience in managed healthcare, network management or reporting, to include a minimum of three (3) years of health care operations, provider network adequacy, or project management experience is required
Advanced proficiency in Microsoft Office Suite to include Word, Excel, Access and PowerPoint
Familiar with a variety of analysis concepts, practices and procedures
Excellent written and verbal communication, facilitation and presentation skills
Strong interpersonal skills and high level of professionalism
Effective listening and critical thinking skills
Effective problem-solving skills with attention to detail
Ability to work independently and within a team
Strong analytical skills
Ability to create and maintain excellent working relationships
Time management skills, ability to develop, prioritize and accomplish goals with a sense of urgency
Ability to effectively interact with all levels of management within the organization and across multiple organizational layers
Ability to multi-task and remain flexible during organizational and/or business changes

Nice To Haves

Experience with provider data repositories and directories preferred

Responsibilities

Manage new and ongoing market network adequacy initiatives from concept to implementation and provide statistics measuring progress throughout.
Perform cost-benefit and return on investment analyses for proposed initiatives to aid in the decision-making process; collect and analyze data in support of business case creation and realization.
Ensure operational effectiveness by assisting in the development of strategic plans for provider contracts, network adequacy, and network performance, including business, financial, and operational goals and objectives; recognize and manage scope and expected outcomes across the Market to HPLC’s strategic initiatives and process improvements.
Coordinate with Corporate business areas to conduct network surveys, data, reporting and analysis of all network adequacy standards to include measuring geographic standards, time and distance standards, appointment wait time standards, LTSS standards, and active provider standards.
Develop oversight and monitoring processes to include identifying gaps, corrective action and executing upon remediation plans to ensure we comply with all adequacy requirements.
Represent and interface as point of contact with regulators as the Network Adequacy Standards Subject Matter Expert to include but not limited to these state agencies: State of Nevada Medicaid, Nevada Health Authority, Department of Insurance.
Assist in the review of reports and data for pattern identification, special cause variation identification, trend analysis, or other techniques; prepare and deliver summaries, recommendations, or alternatives of the analyzed information.
Work closely with member experience/engagement workgroups and business areas to gather/attain data (to include but not limited to access related grievances and complaints, member calls, out of network claims data), conduct analysis and trends to develop remediation and corrective action plans.
Develop, document and perform testing and validation as needed.
Challenge the standard thinking with new ideas, approaches, and solutions which focus on process improvement and growth.
Perform any other job duties as requested.