Network Adequacy Manager
Location: Atlanta, GA
Employment Type: Direct Hire | Full-Time
Salary: $75,000–$100,000 annually
Position Overview
A public-sector regulatory organization is seeking an experienced Network Adequacy Manager to oversee compliance and analytical activities related to healthcare provider network adequacy.
This position serves as a subject matter expert on state and federal network adequacy requirements affecting Qualified Health Plans (QHPs) and off-Exchange Affordable Care Act (ACA) compliant health plans. The Network Adequacy Manager will evaluate provider network sufficiency, oversee regulatory review activities, identify compliance risks and trends, manage assigned staff and vendor partners, and provide recommendations and reporting to agency leadership.
The ideal candidate will bring strong experience in health insurance regulation, managed care, network adequacy, provider network analysis, healthcare compliance, or related regulatory functions, along with the ability to interpret complex state and federal requirements.
Key Responsibilities
- Oversee network adequacy reviews and related regulatory compliance activities for health insurance issuers.
- Serve as a subject matter expert on state and federal network adequacy regulations, policies, methodologies, and performance standards.
- Maintain current knowledge of Centers for Medicare & Medicaid Services (CMS) requirements and applicable state regulations.
- Interpret CMS guidance, the Notice of Benefit and Payment Parameters (NBPP), Final Letters to Issuers, National Association of Insurance Commissioners (NAIC) guidance, and other regulatory publications.
- Review issuer network adequacy submissions and evaluate the sufficiency of healthcare provider networks for on-Exchange and off-Exchange plans.
- Analyze provider network gaps and evaluate issuer explanations and remediation efforts.
- Determine whether identified deficiencies are associated with market limitations, provider availability, recruitment efforts, or other factors.
- Monitor issuer compliance and resolution timelines for escalated cases.
- Produce quarterly and annual network adequacy analyses, dashboards, reports, and leadership briefings.
- Identify statewide trends, emerging compliance concerns, and opportunities for process improvement.
- Manage and provide guidance to analysts responsible for network adequacy reviews, compliance tracking, and issuer support.
- Oversee external vendors providing analytical or technical services and validate the accuracy of dashboards, data outputs, and methodologies.
- Coordinate with internal departments, federal agencies, industry organizations, and external consultants to support timely regulatory and certification review cycles.
- Draft, review, and approve regulatory correspondence, including deficiency notices, corrective action requirements, and compliance determinations.
- Establish and manage annual QHP certification timelines related to network adequacy submissions and reviews.
- Recommend enhancements to policies, procedures, templates, guidance documents, analytical methodologies, and compliance processes.
Qualifications
Successful candidates should possess a combination of experience in areas such as:
- Health insurance regulation or regulatory compliance
- Healthcare provider network adequacy
- Managed care or health plan operations
- ACA and Qualified Health Plan requirements
- Provider network analysis or network management
- CMS regulations and guidance
- Regulatory or compliance analytics
- Insurance issuer oversight
- Healthcare policy or insurance regulation
Previous experience interpreting complex regulatory requirements and translating them into operational or compliance standards is strongly preferred.
Knowledge & Skills
- Strong understanding of healthcare provider networks and network adequacy concepts
- Knowledge of CMS, ACA, QHP, and healthcare insurance regulatory requirements
- Ability to interpret statutes, regulations, regulatory guidance, and technical requirements
- Strong analytical skills with the ability to evaluate network and compliance data
- Ability to identify trends, deficiencies, risks, and potential corrective actions
- Experience developing reports, dashboards, presentations, or executive-level analyses
- Strong written communication skills, particularly for regulatory and compliance correspondence
- Ability to communicate complex regulatory concepts to technical and non-technical audiences
- Strong organizational and project-management capabilities
- Experience managing or providing direction to professional staff
- Ability to coordinate effectively with internal stakeholders, external organizations, vendors, and regulatory partners
Preferred Background
Candidates with experience working for a health insurance carrier, managed care organization, state insurance regulatory agency, healthcare consulting organization, government healthcare program, or other organization responsible for health plan/provider network compliance are strongly encouraged to apply.
Experience with network adequacy reviews, provider network analytics, QHP certification, ACA-compliant health plans, CMS requirements, or NAIC guidance is particularly relevant.
Compensation
$75,000–$100,000 annually, depending on qualifications and relevant experience.
Why Consider This Opportunity?
This position offers an opportunity to apply healthcare insurance and regulatory expertise at a statewide level. The Network Adequacy Manager will play an important role in evaluating healthcare provider network sufficiency, strengthening regulatory compliance processes, identifying statewide trends, and supporting oversight of health plans serving consumers throughout Georgia.
Apply today to be considered for this direct-hire opportunity.
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