Manager, Provider Network Solutions

Medica; Madison (WI); Presencial; USD 89 000 - 133 000; Tempo integral

Resumo da oferta

Medica is a nonprofit health plan serving members across multiple states, including Wisconsin. The Manager, Provider Network Solutions leads the development, implementation, and oversight of provider network strategies to ensure growth, access, and regulatory compliance.

The role partners with stakeholders and vendors to execute complex network initiatives and deliver results. As a people leader, you will guide teams, drive process improvements, and ensure effective execution of provider network

Qualificações

• Bachelor's degree or equivalent in related field.
• 5+ years of work experience beyond degree.
• Advanced data query skills and experience.

Responsabilidades

• Leads provider network strategy and operations to support growth, regulatory compliance, and access objectives.
• Oversees network planning, data integrity, and performance metrics for regulatory reporting.
• Drives cross-functional initiatives, vendor partnerships, and continuous process improvements.
• Mentors teams and ensures adherence to policies, training, and documentation.

Conhecimentos

Advanced data query skills

Formação académica

Bachelor's degree or equivalent in related field

5+ years of work experience beyond degree

Descrição da oferta de emprego

Medica is a nonprofit health plan with more than a million members that serves 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.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Manager, Provider Network Solutions leads the development, implementation, and oversight of provider network solutions that support organizational growth, regulatory compliance, network adequacy, provider access, and operational effectiveness. This role manages teams responsible for provider network analysis, network NCQA HPA deliverables, provider data integrity, regulatory reporting, and multi-state network initiatives. The position partners with business leaders, regulatory stakeholders, and vendors to ensure provider networks meet federal, state, accreditation, and organizational requirements while supporting strategic product and market objectives. As a people leader and subject matter expert, the Manager provides direction for complex network initiatives, drives process improvement, and ensures successful execution of provider network strategies across the organization. Performs other duties as assigned.

Key Accountabilities

• Lead Provider Network Solutions Strategy & Operations
  • Directs provider network solution activities that support organizational growth, product development, network adequacy, and provider access objectives
  • Oversees the development, documentation, and maintenance of network planning processes, policies, procedures, and operational standards
  • Evaluates network performance, operational effectiveness, and service area coverage to identify opportunities for improvement and strategic enhancement
  • Acts as the primary provider network solutions resource for internal business areas, ensuring alignment between network initiatives and organizational goals
• Manage Provider Network Analysis, Access Initiatives and strategic planning
  • Leads teams responsible for analyzing provider network impacts, conducting access assessments, and developing recommendations that support network performance and member access objectives
  • Oversees network coverage strategies and provider data integrity to ensure reliable network information and regulatory compliance
  • Identifies specialty, geographic, and service delivery gaps within provider networks and develops solutions to address access and adequacy needs
  • Partners with leadership and operational teams to support specialty care coverage strategies and network initiatives aligned with business priorities
• Ensure Regulatory Compliance & Network Reporting Excellence
  • Oversees provider network compliance activities to ensure adherence with CMS, NCQA, Department of Labor, state regulatory, Qualified Health Plan, and other applicable requirements
  • Collaborates with Compliance, Regulatory Affairs, and business leaders to interpret regulatory changes and implement required network-related updates
  • Directs the preparation, review, and submission of provider network filings, reports, attestations, and accreditation documentation
  • Monitors regulatory performance metrics and develops corrective action plans to address identified compliance risks or deficiencies
• Manage Cross-Functional Initiatives, Vendor Relationships, & Continuous Improvement
  • Leads provider network projects, product implementations, network launches, and strategic initiatives that support organizational and market objectives
  • Collaborates with business units, vendors, and external partners to coordinate network updates, resolve operational issues, and improve service delivery
  • Assesses operational risks, develops performance measures, and implements process improvements that enhance customer satisfaction and operational efficiency
  • Approves policies, procedures, training materials, and business documentation to support consistent execution of provider network activities and regulatory requirements
• People Leadership
  • Leads and develops employees to achieve business objectives while fostering an inclusive, compliant, and performancedriven work environment
  • Sets clear expectations, provides ongoing coaching and feedback, and supports employees' professional growth
  • Ensures compliance with company policies, employment laws, and HR programs
  • Promotes engagement, collaboration, and accountability while aligning team outcomes with organizational goals

Required Qualifications

• Bachelor's degree or equivalent experience in related field
• 5+ years of work experience beyond degree
• Advanced data query skills and experience

Preferred Qualifications

• 2+ years of leadership experience
• Quest Analytics experience
• QHP / CMS Network Adequacy experience

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 or Madison, WI.

The full salary grade for this position is $88,800 - $152,300. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $88,800 - $133,245. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

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 indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

This employer is required to notify all applicants of their rights pursuant to federal employment laws.

For further information, please review the Know Your Rights notice from the Department of Labor.