Health Plan Network Adequacy Analyst III

Job not on LinkedIn

September 27

🎰 Nevada – Remote

Although this job is listed in Nevada, this company may be open to hiring remote in other states.

💵 $70.8k - $113.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

🦅 H1B Visa Sponsor

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CareSource

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Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

1001 - 5000 employees

Founded 30+ years

⚕️ Healthcare Insurance

📋 Description

• 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; collect and analyze data in support of business case creation and realization. • Assist in the development of strategic plans for provider contracts, network adequacy, and network performance, including business, financial, and operational goals and objectives. • Coordinate with Corporate business areas to conduct network surveys, data, reporting and analysis of all network adequacy standards (geographic standards, time and distance standards, appointment wait time standards, LTSS standards, active provider standards). • Develop oversight and monitoring processes to include identifying gaps, corrective action and executing upon remediation plans to ensure compliance with adequacy requirements. • Represent and interface as point of contact with regulators as the Network Adequacy Standards Subject Matter Expert (including State of Nevada Medicaid, Nevada Health Authority, Department of Insurance). • Review reports and data for pattern identification, special cause variation identification, trend analysis; prepare and deliver summaries, recommendations, or alternatives. • Work closely with member experience/engagement workgroups and business areas to gather data (access related grievances and complaints, member calls, out of network claims data), conduct analysis and trends to develop remediation and corrective action plans. • Develop, document and perform testing and validation as needed. • Challenge standard thinking with new ideas, approaches, and solutions focusing on process improvement and growth. • Perform any other job duties as requested.

🎯 Requirements

• Bachelor’s degree in Healthcare, Health Administration, Public Health, Business, Finance, Economics or related field or equivalent years of relevant work experience is required • Minimum of five (5) years of experience in managed healthcare, network management or reporting • Minimum of three (3) years of health care operations, provider network adequacy, or project management experience • Experience with provider data repositories and directories preferred • Advanced proficiency in Microsoft Office Suite to include Word, Excel, Access 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 within a team • Strong analytical skills • Ability to create and maintain excellent working relationships • Time management skills, ability to develop, prioritize and accomplish goals with a sense of urgency • Ability to effectively interact with all levels of management within the organization and across multiple organizational layers • Ability to multi-task and remain flexible during organizational and/or business changes • Licensure and Certification: None • May be required to travel occasionally

🏖️ Benefits

• In addition to base 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. • WFH (work from home) - Nevada