Network Adequacy Manager
Sign up free to see how well your resume matches this role.
What you'll do
- 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.
What they're looking for
- 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.
Summarised by NextRaise from the employer’s description, which follows in full below.
Full description from employer
Explore a World of Opportunity with the State of Georgia!
We are the force that drives Georgia!
Georgia State Government is a large enterprise, composed of various agencies and entities with a common goal to improve the lives of Georgia's more than 10 million citizens!
Join Team Georgia and impact lives everyday while receiving a robust benefits package designed for every stage of your career!
Job Title:
Network Adequacy ManagerAgency:
Insurance Department of the State of GeorgiaJob Requisition ID:
JR0000004001Shift:
Any (United States of America)Compensation Details:
$75,000 - $100,000Job 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.
Company
Company facts come from this company's own listings. We only show what the postings themselves carry.