Network Adequacy Manager

Insurance Department of the State of Georgia; Walnut Hills (OH); On-site; USD 75,000 - 100,000; Full time

Job summary

The Network Adequacy Manager at the Insurance Department of the State of Georgia ensures issuer compliance with federal and state network adequacy standards. This role serves as the primary authority for oversight of QHP and off-Exchange ACA plans, coordinating with staff, vendors, and external partners to maintain timely review cycles.

You will validate CMS, NBPP, and NAIC guidance, review provider networks for on- and off- Exchange plans, and produce quarterly analyses.

Qualifications

• Bachelor's degree in a related field; three years in a managerial role or seven years in the area with three in management.
• Experience in regulatory compliance and oversight activities.
• Knowledge of CMS NBPP and NAIC guidance is a plus.

Responsibilities

• Oversee analytical activities, supervise staff and vendor partners.
• Ensure timely and accurate review cycles and provide leadership updates.
• Interpret CMS NBPP and NAIC guidance to assess statewide impacts.
• Review issuer network adequacy submissions and evaluate provider network sufficiency.
• Draft, review, and approve deficiency notices and corrective action letters.
• Establish annual QHP certification timelines and coordinate with Georgia Access initiatives.

Skills

Management experience

Regulatory compliance

Education

Bachelor's degree in a related field

Job description

Job Title

Network Adequacy Manager

Agency

Insurance Department of the State of Georgia

Job Requisition ID

JR0000004001

Shift

Any (United States of America)

Compensation Details

$75,000 - $100,000

Job Description

Under supervision, the Network Adequacy Manager is responsible for ensuring issuer compliance with federal and state network adequacy standards, including O.C.G.A. § 33-20E-1 et seq. and Centers for Medicare and Medicaid Services (CMS) requirements under 45 CFR 156.230. This role serves as the State of Georgia’s primary authority for network adequacy oversight for Qualified Health Plans (QHP) and off-Exchange Affordable Care Act (ACA) compliant plans. Oversee analytical activities, supervises staff and vendor partners, ensures timely and accurate review cycles, identifies issuer performance trends, and provides recurring updates to leadership regarding compliance risks and statewide network sufficiency. Maintain expert-level knowledge of Georgia-specific network adequacy requirements and align guidance with Centers for Medicare and Medicaid Services (CMS) standards. Serve as the subject matter expert on federal and state network adequacy regulations, policies, methodologies, and performance metrics. Interpret Centers for Medicare and Medicaid Services (CMS), Notice of Benefit and Payment Parameters (NBPP), Final Letters to Issuers, NAIC guidance, and regulatory publications to assess statewide impacts. Review issuer network adequacy submissions and evaluate provider network sufficiency for on-Exchange and off-Exchange plans. Validate issuer justifications for provider network gaps and determine whether deficiencies reflect market constraints or inadequate recruitment. Produce quarterly and annual adequacy analyses, dashboards, and leadership briefings to identify statewide trends. Manage the work of assigned analysts responsible for adequacy reviews, compliance tracking, and issuer support. Oversee vendors providing analytical and technical services; validate dashboards, data outputs, and methodology enhancements. Coordinate with agency divisions, Centers for Medicare and Medicaid Services (CMS), National Association for Insurance Commissioners (NAIC), and external consultants to ensure operational alignment and timely certification review cycles. Draft, review, and approve issuer correspondence regarding deficiency notices, corrective action requirements, and compliance determinations. Establish annual Qualified Health Plans (QHP) certification timelines for adequacy submission review and align with Georgia Access program timelines. Monitor compliance status and resolution timelines for escalated issuer cases. Recommend enhancements to templates, procedures, policy guidance, and analytical approaches. Perform other duties as assigned.

Minimum Qualifications

• Bachelor's degree in a related field from an accredited college or university and three (3) years in a managerial role in the area of assignment;
• or seven (7) years of experience in the area of assignment, including three (3) years in a managerial role;
• or one (1) year of experience required at the lower level Mgr 2, Regulatory Compliance (RCM051) or position equivalent.

Equal Employment Opportunity Employer

The State of Georgia does not discriminate based on race, color, national origin, sex, religion, age, disability, or other protected categories in employment or the provision of services. Qualified applicants may request reasonable accommodation when needed during the application and/or screening process by contacting the appropriate agency Human Resources department.

About the State

Georgia State Government is a large enterprise, composed of various entities with a common goal to improve the lives of Georgia's 10 million citizens. With nearly 62,000 employees, we are one of the single largest employer in the state. Public service opportunities stretch across the state as employees live and work in all 159 counties. From traditional fields such as accounting, nursing, and engineering to unique fields like forestry and natural resources management, Georgia state government provides a world of opportunity.