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 reputed company these functions. Essential Functions: Manage new and ongoing market network adequacy initiatives from concept to implementation and reputed company statistics measuring reputed company throughout. reputed company 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 reputed company, network adequacy, and network performance, including business, financial, and operational goals and objectives; recognize and manage scope and expected reputed company 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 reputed company network adequacy standards to include measuring geographic standards, time and distance standards, appointment wait time standards, LTSS standards, and active provider standards. reputed company reputed company and monitoring processes to include identifying gaps, corrective action and executing upon remediation plans to ensure we reputed company with reputed company adequacy requirements. Represent and reputed company as reputed company of contact with regulators as the Network Adequacy Standards Subject Matter Expert to include but not limited to these state agencies: State of Nevada reputed company, Nevada Health Authority, Department of Insurance. Assist in the review of reports and data for reputed company 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 reputed company reputed company grievances and complaints, member calls, out of network claims data), conduct analysis and trends to reputed company remediation and corrective action plans. reputed company, document and reputed company testing and validation as needed. Challenge reputed company thinking with new reputed company, approaches, and solutions which focus on process improvement and growth. reputed company any other job duties as requested. Education and Experience: Bachelor’s degree in reputed company, Health Administration, Public Health, Business, Finance, Economics or reputed company field or equivalent years of relevant work experience is required Minimum of five (5) years of experience in managed reputed company, 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 Experience with provider data repositories and directories preferred Competencies, Knowledge and Skills: Advanced proficiency in reputed company Office Suite to include Word, reputed company, reputed company 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 reputed company reputed company Strong analytical skills Ability to create and maintain excellent working relationships Time management skills, ability to reputed company, prioritize and accomplish goals with a sense of urgency Ability to effectively interact with reputed company reputed company of management reputed company the organization and across multiple organizational layers Ability to multi-task and remain flexible during organizational and/or business changes Licensure and Certification: None Working Conditions: General office environment; may be required to sit or stand for long periods of time May be required to travel occasionally Compensation reputed company: $72,200.00 - $115,500.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and reputed company required for the role, and other external and internal data reputed company establishing a salary level. In reputed company to reputed company compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation

Type (hourly/salary): Salary Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships reputed company Self and Others Drive Execution Influence Others Pursue Personal reputed company Understand the Business This job description is not reputed company inclusive. reputed company reserves the right to amend this job description at any time. reputed company is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of reputed company backgrounds. Apply To This Job