Manager, Provider Network Solutions

Medica • Madison, WI

4d • $88,800 - $133,245 • Hybrid

About The Position

The Manager, Provider Network Solutions leads the development, implementation, and oversight of provider network solutions that support organizational growth, regulatory compliance, network adequacy, provider access, and operational effectiveness. The role manages teams responsible for provider network analysis, network NCQA HPA deliverables, provider data integrity, regulatory reporting, and multi-state network initiatives. The Manager partners with business leaders, regulatory stakeholders, and vendors to ensure networks meet federal, state, accreditation, and organizational requirements while supporting strategic product and market objectives. As a people leader and subject matter expert, this position directs complex network initiatives, drives process improvement, and ensures successful execution of provider network strategies. Other duties may be assigned.

This is an office role requiring onsite work an average of three days per week. Candidates may be located near Medica’s offices in Minnetonka, Minnesota, or Madison, Wisconsin. The role does not offer work visa sponsorship; candidates must be legally authorized to work in the United States at the time of application.

Requirements

• Bachelor’s degree or equivalent experience in a related field.
• At least 5 years of work experience beyond the degree.
• Advanced data query skills and experience.

Nice To Haves

• At least 2 years of leadership experience.
• Quest Analytics experience.
• QHP / CMS Network Adequacy experience.

Responsibilities

• Direct provider network solution activities supporting organizational growth, product development, network adequacy, and provider access objectives.
• Oversee development, documentation, and maintenance of network planning processes, policies, procedures, and operational standards.
• Evaluate network performance, operational effectiveness, and service area coverage to identify opportunities for improvement and strategic enhancement.
• Serve as the primary provider network solutions resource for internal business areas and align network initiatives with organizational goals.
• Lead teams analyzing provider network impacts, conducting access assessments, and developing recommendations for network performance and member access.
• Oversee network coverage strategies and provider data integrity to maintain reliable network information and regulatory compliance.
• Identify specialty, geographic, and service delivery gaps in provider networks and develop solutions to address access and adequacy needs.
• Partner with leadership and operational teams on specialty care coverage strategies and network initiatives aligned with business priorities.
• Oversee provider network compliance with CMS, NCQA, Department of Labor, state regulatory, Qualified Health Plan, and other applicable requirements.
• Collaborate with Compliance, Regulatory Affairs, and business leaders to interpret regulatory changes and implement network-related updates.
• Direct preparation, review, and submission of provider network filings, reports, attestations, and accreditation documentation.
• Monitor regulatory performance metrics and develop corrective action plans to address compliance risks or deficiencies.
• Lead provider network projects, product implementations, network launches, and strategic initiatives supporting organizational and market objectives.
• Collaborate with business units, vendors, and external partners to coordinate network updates, resolve operational issues, and improve service delivery.
• Assess operational risks, develop performance measures, and implement process improvements to enhance customer satisfaction and operational efficiency.
• Approve policies, procedures, training materials, and business documentation supporting consistent provider network activities and regulatory compliance.
• Lead and develop employees, set expectations, provide coaching and feedback, and support professional growth.
• Ensure compliance with company policies, employment laws, and HR programs; promote engagement, collaboration, accountability, and an inclusive, performance-driven work environment.
• Perform other duties as assigned.

Benefits

• Competitive medical, dental, and vision benefits.
• Paid time off (PTO) and holidays.
• Paid volunteer time off.
• 401(k) contributions.
• Caregiver services.
• The position may be eligible for incentive plan compensation in addition to base salary.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager