Network Adequacy Manager

Network Adequacy Manager | Health Insurance Regulatory Compliance

Location: Atlanta, GA

Employment Type: Full-Time | Direct Hire

Work Arrangement: Onsite

Salary: $75,000–$100,000 annually

Position Overview

Focus People is partnering with a public-sector regulatory organization in Atlanta to identify an experienced Network Adequacy Manager to provide leadership and subject-matter expertise in health insurance network adequacy, provider network compliance, and regulatory oversight .

This position will play a key role in ensuring health insurance issuers comply with applicable state and federal network adequacy requirements , including standards established by the Centers for Medicare & Medicaid Services (CMS) . The Network Adequacy Manager will support oversight of Qualified Health Plans (QHPs) and off-Exchange ACA-compliant health plans , evaluate provider network sufficiency, identify compliance risks and trends, and provide guidance to agency leadership.

The ideal candidate brings experience from a health insurance carrier, managed care organization, state insurance regulatory agency, CMS/QHP environment, or healthcare regulatory consulting organization and understands how provider networks are evaluated for regulatory compliance.

Key Responsibilities

• Serve as a subject-matter expert on network adequacy , provider network compliance, and applicable state and federal regulatory requirements.
• Interpret and apply CMS network adequacy requirements, ACA/QHP regulations, regulatory guidance, methodologies, and performance standards .
• Review health insurance issuer network adequacy submissions and evaluate provider networks for sufficiency and regulatory compliance.
• Analyze provider access, network gaps, and issuer explanations for deficiencies to determine whether gaps reflect legitimate market constraints or inadequate provider recruitment.
• Oversee analytical activities related to provider network adequacy, network sufficiency, compliance tracking, and issuer performance .
• Identify emerging compliance risks and network adequacy trends and communicate findings to agency leadership.
• Develop and present quarterly and annual analyses, dashboards, reports, and leadership briefings .
• Supervise assigned analysts supporting network adequacy reviews, issuer compliance activities, and regulatory review cycles.
• Oversee external vendors and validate analytical methodologies, dashboards, data outputs, and process enhancements.
• Coordinate with internal agency divisions, CMS, NAIC, external consultants, and other regulatory stakeholders during certification and compliance review cycles.
• Draft, review, and approve regulatory correspondence involving network deficiencies, corrective actions, compliance determinations, and issuer responses .
• Establish and manage annual QHP certification and network adequacy review timelines .
• Monitor escalated issuer compliance matters and corrective-action timelines through resolution.
• Recommend improvements to regulatory procedures, analytical methodologies, templates, policies, and compliance guidance.

Qualifications

• Professional experience in health insurance, managed care, healthcare regulatory compliance, provider network management, network adequacy, or insurance regulation .
• Strong understanding of healthcare regulatory requirements and the ability to interpret complex federal and state regulations.
• Experience working with CMS requirements, health plans, managed care organizations, insurance issuers, or healthcare regulatory agencies .
• Demonstrated experience analyzing healthcare, compliance, provider, or network-related data and translating findings into actionable recommendations.
• Experience leading complex regulatory, compliance, analytical, or operational initiatives.
• Strong analytical and problem-solving skills with the ability to identify trends, deficiencies, and regulatory risks.
• Experience communicating complex regulatory or analytical findings to senior leadership and external stakeholders.
• Leadership experience supervising employees, project teams, consultants, or vendors.
• Strong written communication skills, including experience developing reports, regulatory correspondence, policies, procedures, or executive-level presentations.

Highly Preferred Experience

Candidates with direct experience in one or more of the following areas are strongly encouraged to apply:

• Network Adequacy
• Provider Network Compliance
• Provider Network Sufficiency / Provider Access
• CMS Network Adequacy Standards
• Affordable Care Act (ACA)
• Qualified Health Plans (QHPs)
• Managed Care / Health Plan Compliance
• Health Insurance Regulatory Oversight
• Issuer Network Submissions
• Network Gap Analysis
• Corrective Action / Regulatory Compliance Reviews
• NAIC Guidance
• QHP Certification
• State Department of Insurance or other healthcare regulatory agency experience

Ideal Candidate Background

Strong candidates may currently or previously have held titles such as:

Network Adequacy Manager, Provider Network Manager, Network Compliance Manager, Network Adequacy Analyst, Provider Network Adequacy Analyst, Managed Care Compliance Manager, QHP Compliance Manager, Healthcare Regulatory Compliance Manager, Health Insurance Regulatory Analyst, Provider Network Analytics Manager, or Network Management Manager.

Experience with a health insurance carrier, managed care organization, state Department of Insurance, healthcare regulatory agency, ACA/QHP program, or healthcare regulatory consulting firm is particularly relevant.

Why Consider This Opportunity?

This position offers an opportunity to take significant ownership of health plan network adequacy oversight and contribute to how provider network compliance is evaluated across Georgia's individual health insurance market.

The Network Adequacy Manager will work at the intersection of health insurance regulation, provider access, analytics, compliance, and public policy , while serving as a trusted resource to agency leadership and external regulatory stakeholders.

If you have experience evaluating health plan provider networks, network adequacy, managed care compliance, or CMS/ACA regulatory requirements , we encourage you to apply.

Focus People is an Equal Opportunity Employer.