Medica
Director, Network Adequacy & Provider Directories
Medica, Hopkins, Minnesota, United States, 55305
Overview
Director, Network Adequacy & Provider Directories is a strategic leader responsible for ensuring the health plan maintains compliant, accurate, and member-friendly provider networks. This role oversees all aspects of network adequacy strategy, regulatory reporting, and provider directory accuracy. The Director leads cross-functional initiatives to strengthen access-to-care, improve provider data integrity, and meet CMS and state regulatory requirements. They are also responsible for vendor relationships and oversight to manage regulatory needs and data analysis. Medica is a nonprofit health plan serving communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for. Key Accountabilities
Regulatory Compliance & Reporting Lead enterprise compliance with CMS, State, and Federal network adequacy standards Serve as the primary liaison with regulators regarding adequacy and directory requirements Develop and manage reporting processes for adequacy filings, directory attestations, and audits Establish SLAs, KPIs, and quality controls for directory accuracy Provider Directory Accuracy & Data Integrity Oversee provider directory accuracy initiatives, ensuring data integrity and regulatory alignment Lead directory accuracy initiatives to ensure transparency for members and regulators Oversee day-to-day operations of provider directory management Drive adoption of master data management and enterprise data governance Technology & Vendor Management Evaluate and implement vendor technologies that enhance adequacy monitoring and directory accuracy Manage relationships with vendors supporting provider data and adequacy assessments Develop dashboards for network adequacy monitoring and directory accuracy Cross-Functional Collaboration Partner with Network Contracting to ensure timely updates to new and terminated providers Partner with Sales, Product, and Network Contracting to assess adequacy during new market expansions Direct cross-functional initiatives across Network Management, Provider Data Operations, Compliance, IT, and Member Experience Strategic Planning & Risk Forecasting Develop workforce planning models to forecast adequacy risks (e.g., specialty gaps, geographic shortages) Qualifications
Bachelor\'s degree in healthcare administration, business, or equivalent experience in related field 10 years of experience in network management, provider data operations, or health plan compliance 5 years of leadership experience Skills & Abilities
Proven leadership in regulatory compliance and cross-functional program management Strong understanding of CMS and state adequacy requirements Experience with provider data systems, master data management, and data governance Excellent communication and stakeholder engagement skills Ability to manage vendor relationships and evaluate technology solutions Work Location & Compensation
This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, Madison, WI, Omaha, NE, or St. Louis, MO. Base pay range: $111,200.00/yr - $190,600.00/yr. The full salary grade for this position is $111,200 - $190,600. Typical hiring salary range is $111,200 - $166,740, with final placement based on factors including education, experience, certifications, scope of role, and internal/external market data. In addition to base compensation, this position may be eligible for incentive plan compensation. Medica offers a comprehensive benefits package. Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States. We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment regardless of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, or any other protected characteristic.
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Director, Network Adequacy & Provider Directories is a strategic leader responsible for ensuring the health plan maintains compliant, accurate, and member-friendly provider networks. This role oversees all aspects of network adequacy strategy, regulatory reporting, and provider directory accuracy. The Director leads cross-functional initiatives to strengthen access-to-care, improve provider data integrity, and meet CMS and state regulatory requirements. They are also responsible for vendor relationships and oversight to manage regulatory needs and data analysis. Medica is a nonprofit health plan serving communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for. Key Accountabilities
Regulatory Compliance & Reporting Lead enterprise compliance with CMS, State, and Federal network adequacy standards Serve as the primary liaison with regulators regarding adequacy and directory requirements Develop and manage reporting processes for adequacy filings, directory attestations, and audits Establish SLAs, KPIs, and quality controls for directory accuracy Provider Directory Accuracy & Data Integrity Oversee provider directory accuracy initiatives, ensuring data integrity and regulatory alignment Lead directory accuracy initiatives to ensure transparency for members and regulators Oversee day-to-day operations of provider directory management Drive adoption of master data management and enterprise data governance Technology & Vendor Management Evaluate and implement vendor technologies that enhance adequacy monitoring and directory accuracy Manage relationships with vendors supporting provider data and adequacy assessments Develop dashboards for network adequacy monitoring and directory accuracy Cross-Functional Collaboration Partner with Network Contracting to ensure timely updates to new and terminated providers Partner with Sales, Product, and Network Contracting to assess adequacy during new market expansions Direct cross-functional initiatives across Network Management, Provider Data Operations, Compliance, IT, and Member Experience Strategic Planning & Risk Forecasting Develop workforce planning models to forecast adequacy risks (e.g., specialty gaps, geographic shortages) Qualifications
Bachelor\'s degree in healthcare administration, business, or equivalent experience in related field 10 years of experience in network management, provider data operations, or health plan compliance 5 years of leadership experience Skills & Abilities
Proven leadership in regulatory compliance and cross-functional program management Strong understanding of CMS and state adequacy requirements Experience with provider data systems, master data management, and data governance Excellent communication and stakeholder engagement skills Ability to manage vendor relationships and evaluate technology solutions Work Location & Compensation
This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, Madison, WI, Omaha, NE, or St. Louis, MO. Base pay range: $111,200.00/yr - $190,600.00/yr. The full salary grade for this position is $111,200 - $190,600. Typical hiring salary range is $111,200 - $166,740, with final placement based on factors including education, experience, certifications, scope of role, and internal/external market data. In addition to base compensation, this position may be eligible for incentive plan compensation. Medica offers a comprehensive benefits package. Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States. We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment regardless of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, or any other protected characteristic.
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