Manager, Provider Network Solutions

Health insurance that's with you, every step of the way. • Minnetonka, MN

3d • Hybrid

About The Position

Medica is a nonprofit health plan serving more than a million members in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. 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 provider networks meet federal, state, accreditation, and organizational requirements while supporting strategic product and market objectives. As a people leader and subject matter expert, the Manager directs complex network initiatives, drives process improvement, and ensures successful execution of provider network strategies across the organization. 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 the Minnetonka, Minnesota, or Madison, Wisconsin office. The position does not offer work visa sponsorship; applicants 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 the 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 that support network performance and member access.
• Oversee network coverage strategies and provider data integrity to ensure reliable network information and regulatory compliance.
• Identify specialty, geographic, and service-delivery gaps in provider networks and develop solutions addressing 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 required network 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.
• Coordinate network updates with business units, vendors, and external partners; resolve operational issues and improve service delivery.
• Assess operational risks, develop performance measures, and implement process improvements that improve customer satisfaction and operational efficiency.
• Approve policies, procedures, training materials, and business documentation supporting consistent execution of provider network activities and regulatory requirements.
• Lead and develop employees to achieve business objectives while fostering an inclusive, compliant, and performance-driven work environment.
• Set clear expectations, provide ongoing coaching and feedback, and support employees’ professional growth.
• Ensure compliance with company policies, employment laws, and HR programs.
• Promote engagement, collaboration, and accountability while aligning team outcomes with organizational goals.

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