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Role Description

This role is instrumental in shaping high-performing provider networks that ensure access, compliance, and long-term market success. You will serve as a subject matter expert, translating strategy into actionable network solutions while balancing regulatory requirements and operational efficiency. The position involves evaluating network designs, coordinating network builds and expansions, and monitoring ongoing performance to ensure continuity of care. You will collaborate across internal teams and external partners to resolve complex issues and drive process improvements. This is a highly analytical, detail-oriented role in a fast-paced, collaborative environment, providing the opportunity to impact healthcare delivery on a large scale.

• Serve as the expert on alternative access networks, including provider inclusion/exclusion criteria, anchor providers, and network adequacy standards.
• Evaluate network design options and provide data-driven recommendations that balance access, compliance, and market needs.
• Lead end-to-end network build, reconfiguration, and expansion efforts by translating contracting intent into operational direction.
• Partner with Compliance to support regulatory submissions, filings, and ongoing adherence to state and federal requirements.
• Monitor network adequacy, quality, and performance, identifying risks and recommending corrective actions.
• Manage implementation milestones, dependencies, and post-implementation activities, including market sign-offs and network integrity checks.
• Collaborate with regional and national stakeholders to resolve escalations and ensure seamless continuity of care.
• Contribute to training, documentation, and continuous improvement initiatives, providing guidance to other Network Operations Advisors as needed.

Qualifications

• 5+ years of experience in managed healthcare or a related field.
• 3+ years of experience in provider contracting, provider services, network management, product, or compliance.
• Strong knowledge of provider networks, network adequacy standards, and healthcare professional data structures.
• Proficient in Excel and data analysis tools; strong analytical, critical thinking, and problem-solving skills.
• Ability to work effectively in a fast-paced, matrixed environment and influence across teams.
• Preferred: Bachelor’s degree or equivalent professional experience.
• Preferred: Experience supporting commercial and/or government healthcare products.
• Preferred: Familiarity with regulatory requirements related to network adequacy and provider access, provider contracting systems, and data mining.
• Strong project management, stakeholder communication, and collaboration skills.
• Reliable high-speed internet connection (minimum 10 Mbps download/5 Mbps upload) if working remotely.

Benefits

• Annual salary range: $79,700 – $132,800 USD, depending on experience and location.
• Eligibility to participate in an annual bonus plan.
• Comprehensive health benefits including medical, dental, vision, and behavioral health programs starting on day one.
• 401(k) plan with company match and company-paid life insurance.
• Tuition reimbursement and professional development opportunities.
• Paid time off with a minimum of 18 days per year, plus paid holidays.
• Supportive work environment focused on collaboration, compliance, and continuous improvement.