Health Plan Network Adequacy Analyst III

Job Summary:

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.

Essential Functions:

• 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 an...