Strategic Network Adequacy Lead

Focus People; Atlanta (GA); On-site; USD 75,000 - 100,000; Full time

Job summary

Focus People is seeking a Network Adequacy Manager in Atlanta, GA to oversee regulatory compliance and provider network analyses for QHPs and ACA-compliant plans. The role requires expertise in health insurance regulation, CMS guidance, and cross-functional oversight of staff and vendors.

You will produce quarterly and annual network analyses, maintain up-to-date CMS knowledge, and communicate regulatory findings to agency leadership.

Qualifications

• Experience in health insurance regulation or regulatory compliance.
• Knowledge of ACA, QHP, and CMS requirements.
• Ability to interpret statutes and regulations for operational use.
• Experience building dashboards and executive analyses.

Responsibilities

• Oversee network adequacy reviews and regulatory compliance for health issuers.
• Serve as SME on state and federal network adequacy regulations.
• Maintain knowledge of CMS requirements and NBPP guidance.
• Review network submissions and evaluate sufficiency of provider networks.
• Produce quarterly/annual analyses and leadership briefings.
• Lead analysts and coordinate with vendors and regulators.
• Draft regulatory correspondence and actions.

Skills

Network adequacy

Regulatory compliance

CMS regulations

Data analysis

Staff management

Vendor management

Regulatory reporting

Job description

Focus People is seeking a Network Adequacy Manager in Atlanta, GA to oversee regulatory compliance and provider network analyses for QHPs and ACA-compliant plans. The role requires expertise in health insurance regulation, CMS guidance, and cross-functional oversight of staff and vendors.

You will produce quarterly and annual network analyses, maintain up-to-date CMS knowledge, and communicate regulatory findings to agency leadership.