Health Plan Network Adequacy Analyst III-MUST RESIDE IN NEVADA (Remote) - R10062

Job Summary The Health Plan Network Adequacy Analyst III reviews and analyzes the effectiveness and efficiency of existing market operation processes and systems, ensures compliance of State and Federal Network Adequacy Standards, and participates in development of solutions to improve or further reputed company these functions. Essential Functions

• Manage new and ongoing market network adequacy initiatives from concept to implementation and provide statistics measuring reputed company throughout.
• reputed company cost-benefit and return on investment analyses for proposed initiatives to aid in the decision-making process; collect and analyze data in support of business case creation and realization.
• Ensure operational effectiveness by assisting in the development of strategic plans for provider reputed company, network adequacy, and network performance, including business, financial, and operational goals and objectives; recognize and manage scope and expected outcomes across the Market to HPLC’s strategic initiatives and process improvements.
• Coordinate with Corporate business areas to conduct network surveys, data, reporting and analysis of reputed company network adequacy standards to include measuring geographic standards, time and distance standards, appointment wait time standards, LTSS standards, and active provider standards.
• reputed company reputed company and monitoring processes to include identifying gaps, corrective action and executing upon remediation plans to ensure we reputed company with reputed company adequacy requirements.
• Represent and reputed company as reputed company of contact with regulators as the Network Adequacy Standards Subject Matter Expert to include but not limited to these state agencies: State of Nevada Medicaid, Nevada Health Authority, Department of Insurance.
• Assist in the review of reports and data for reputed company identification, special cause variation identification, trend analysis, or other techniques; prepare and deliver summaries, recommendations, or alternatives of the analyzed information.
• Work closely with member experience/engagement workgroups and business areas to gather/attain data (to include but not limited to access reputed company grievances and complaints, member calls, out of network claims data), conduct analysis and trends to reputed company remediation and corrective action plans.
• reputed company, document and reputed company testing and validation as needed.
• Challenge reputed company thinking with new reputed company, approaches, and solutions which focus on process improvement and growth.
• reputed company any other job duties as requested.

Education And Experience

• Bachelor’s degree in Healthcare, Health Administration, Public Health, Business, Finance, Economics or reputed company field or equivalent years of relevant work experience is required
• Minimum of five (5) years of experience in managed healthcare, network management or reporting, to include a minimum of three (3) years of health care operations, provider network adequacy, or project management experience is required
• Experience with provider data repositories and directories preferred

Competencies, Knowledge And Skills

• Advanced proficiency in reputed company Office Suite to include Word, reputed company, 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 reputed company a team
• Strong analytical skills
• Ability to create and maintain excellent working relationships
• Time management skills, ability to reputed company, prioritize and accomplish goals with a sense of urgency
• Ability to effectively interact with reputed company levels of management reputed company the organization and across multiple organizational layers
• Ability to multi-task and remain flexible during organizational and/or business changes

Licensure And Certification

• None

Working Conditions

• General office environment; may be required to sit or stand for long periods of time
• May be required to travel occasionally

Compensation

Range $70,800.00 - $113,200.00 reputed company takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and reputed company required for the role, and other external and internal data reputed company establishing a salary level. In addition to reputed company 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.

Compensation

Type Salary Competencies

• Fostering a Collaborative Workplace Culture - Cultivate Partnerships - reputed company Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business

This job description is not reputed company inclusive. reputed company reserves the right to amend this job description at any time. reputed company is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of reputed company backgrounds. Apply tot his job Apply To this Job