Network Access and Adequacy Program Manager

Job Title	Network Access and Adequacy Program Manager
Requisition #	24774
Exemption Status	Exempt
Management Level	n/a
Direct Reports	n/a
Manager Title	Operations Manager - Provider Network
Department	Provider Network Operations
Pay and Benefits	Estimated hiring range $88,430 - $108,080 /year, 5% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits
Posting Notes	This is a hybrid role that will require you to go into the downtown Portland office 1-2 times per week.

Job Summary

The Network Access and Adequacy Program Manager oversees CareOregon's Network Access and Adequacy Program, ensuring compliance with regulatory standards and supporting organizational goals for provider accessibility and adequacy. This role is pivotal in advancing CareOregon's strategic goals by driving network optimization, compliance, and performance metrics aligned with the organization's long-term growth and member access needs. The Program Manager collaborates with internal teams and external partners to address network gaps, align strategic objectives, and improve network performance. Key responsibilities include managing the program, implementing corrective actions, driving data analysis and process improvement, and supporting readiness for quality accreditation. The Program Manager also leads staff training and stakeholder engagement to enhance program knowledge and visibility across the organization.

Essential Responsibilities

Program Management and Staff Development

• Lead the development and business operations of the Network Access and Adequacy Program, coordinating efforts to identify, implement, and achieve program goals and performance metrics that meet and exceed regulatory requirements while advancing the organization's strategic objectives.
• Maintain a catalog of program-related compliance requirements, ensuring all are accounted for in policy and procedure and that business processes are routinely monitored for adherence.
• Implement, and support the resolution of, corrective action initiatives where appropriate and in collaboration with the Compliance department.
• Lead the development, implementation, and business operations, of the network access and adequacy governance framework, establishing policies, coordinating and executing governance goals, and ensuring thorough documentation and clear communication across all involved groups.
• Implement and leverage best practices in project management, change management, and quality improvement to optimize provider network and program performance.
• Serve as the program's internal primary point of contact for related issues and questions, facilitating open communication and addressing concerns to uphold the organization's accessibility and quality standards.
• Cultivate and maintain collaborative relationships with key external stakeholders, including provider groups, regulatory agencies, and healthcare partners, in support of program objectives and compliance.
• Collaborate with leadership to support the implementation and execution of various strategic network development and optimization initiatives, ensuring alignment with the organization's long-term goals for provider accessibility and quality.
• Lead the development, delivery, and maintenance of training materials related to program activities, compliance, and goals, ensuring team alignment and engagement.

Program Development and Strategic Planning

• Lead the continuous development and improvement of the Network Access and Adequacy Program as it relates to current and anticipated compliance standards.
• Consolidate program efforts with cross-functional teams to develop and execute strategic network adequacy initiatives, addressing both organizational and regulatory priorities.
• Collaborate across teams to analyze market trends, member needs, provider needs, and other relevant consumer sentiment and effort data to identify opportunities for future network and program innovation.
• Collaborate with executive leadership to align network sustainability and adequacy objectives with organizational goals, supporting strategic planning and risk assessment efforts.
• Lead organizational readiness and improvement initiatives for NCQA Quality Accreditation by aligning Network Access and Adequacy Program functions and standards with NCQA requirements and developing comprehensive work plans to enhance program quality and eligibility for certification.

Data Analysis and Reporting

• Conduct ongoing data analyses to identify gaps in provider availability and accessibility, generating actionable insights that inform network expansion and adequacy initiatives and support data-driven decision-making.
• Collaborate with data analysts and quality improvement teams to collect, analyze, and interpret data, providing leadership with regular, actionable reports on program performance.
• Develop, maintain, and distribute routinely updated program performance and key metric reports, leveraging dashboards and other reporting tools to support program visibility and transparency.

Organizational Responsibilities

• Perform work in alignment with the organization's mission, vision and values.
• Support the organization's commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
• Strive to meet annual business goals in support of the organization's strategic goals.
• Adhere to the organization's policies, procedures and other relevant compliance needs.
• Perform other duties as needed.

Experience and/or Education

Required

• 5 years' experience in network adequacy, healthcare operations, or a related field, including regulatory compliance and program management
• 3 years' experience with regulatory requirements in healthcare network adequacy

Preferred

• Experience working with Medicaid and Medicare Advantage plans, especially within Oregon
• Formal training in LEAN, Six Sigma, or similar process improvement methodologies
• Applied NCQA experience and knowledge

Knowledge, Skills and Abilities Required

Knowledge

• Advanced understanding of project and program management principles, methods, and techniques, particularly as applied to healthcare and provider network operations
• Advanced understanding of health system and health plan operations
• Advanced understanding of healthcare terminology
• Strong understanding of Oregon Medicaid or Medicare in area of focus, including state and federal network access and adequacy regulations and requirements
• Strong understanding of quality assessment measures
• Strong understanding of healthcare network structures, quality improvement, health plan financing, and health outcome measures
• Strong understanding of provider development, education, and relations
• Strong understanding of techniques used in change management
• Strong understanding of healthcare data systems and analytic tools used for clinical care support and quality measurement

Skills and Abilities

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  Advanced computer application skills, including with Microsoft 365 Office products (Word, Excel, Outlook, PowerPoint, etc.), and Microsoft and Google-based internet browsers and search functions.

  
  
• Advanced skills in process improvement and the application of LEAN or similar methodologies designed for driving operational efficiency
• Advanced organizational skills, with the ability to manage multiple priorities and projects at once, ensuring timely completion and consistent quality outcomes
• Advanced skills in various project management software and data analysis tools, such as Smartsheet, Mural, Tableau, or similar
• Advanced verbal and written communication and presentation skills, including the ability to articulate and deliver complex concepts clearly to a wide range of internal and external audiences in a way that drives program success
• Advanced skills in analyzing complex data sets, interpreting trends, and developing actionable strategies to address identified gaps
• Strong facilitation and stakeholder engagement skills, with the ability to collaborate cross-functionally to achieve program goals in both virtual and in-person settings
• Strong skills in negotiation, with the ability to influence program outcomes and advocate effectively for program resources and investments
• Strong ability to develop, recommend, and implement policies, procedures, and guidelines
• Strong ability to create and manage visual displays or maps of processes, timelines, or projects
• Ability to develop and maintain strong professional working relationships with internal and external colleagues, customers, and stakeholders
• Ability to effectively solve unique problems as they arise and to identify when to redirect issues appropriately
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to hear and speak clearly for at least 3-6 hours/day

• Ability to work effectively with diverse individuals and groups

• Ability to learn, focus, understand, and evaluate information and determine appropriate actions

Working Conditions

Work Environment(s): Indoor/Office Community Facilities/Security Outdoor Exposure

Member/Patient Facing: No Telephonic In Person

Hazards: May include, but not limited to, physical and ergonomic hazards.

Equipment: General office equipment

Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used.

Work Location: Hybrid-Office 1-2 days/month

#Li-Hybrid

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.

Veterans are strongly encouraged to apply.

We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.

Visa sponsorship is not available at this time.