Director, Network Adequacy

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Director of Network Adequacy & Provider Directories is a strategic leader responsible for ensuring the health plan maintains compliant, accurate, and member-friendly provider networks. This role oversees all aspects of network adequacy strategy, regulatory reporting, and provider directory accuracy. The Director will lead cross-functional initiatives across Network Management, Provider Data Operations, Product, Markets, Compliance, IT, and Member Experience to strengthen access-to-care, improve provider data integrity, and meet all CMS and state regulatory requirements. The Director will also be responsible for vendor relationships and oversight to manage regulatory needs and data analysis. Performs other duties as assigned.

Key Accountabilities

• Regulatory Compliance & Reporting

• Lead enterprise compliance with CMS, State, and Federal network adequacy standards

• Serve as the primary liaison with regulators regarding adequacy and directory requirements
• Develop and manage reporting processes for adequacy filings, directory attestations, and audits

• Establish SLAs, KPIs, and quality controls for directory accuracy

• Provider Directory Accuracy & Data Integrity

• Oversee provider directory accuracy initiatives, ensuring data integrity and regulatory alignment

• Lead directory accuracy initiatives to ensure transparency for members and regulators
• Oversee day-to-day operations of provider directory management

• Drive adoption of master data management and enterprise data governance

• Technology & Vendor Management

• Evaluate and implement vendor technologies that enhance adequacy monitoring and directory accuracy

• Manage relationships with vendors supporting provider data and adequacy assessments

• Develop dashboards for network adequacy monitoring and directory accuracy

• Cross-Functional Collaboration

• Partner with Network Contracting to ensure timely updates to new and terminated providers

• Partner with Sales, Product, and Network Contracting to assess adequacy during new market expansions

• Direct cross-functional initiatives across Network Management, Provider Data Operations, Compliance, IT, and Member Experience

• Strategic Planning & Risk Forecasting

• Develop workforce planning models to forecast adequacy risks (e.g., specialty gaps, geographic shortages)

Required Qualifications

• Bachelor's degree in healthcare administration, business, or equivalent experience in related field
• 10 years of experience in network management, provider data operations, or health plan compliance
• 5 years of leadership experience

Skills And Abilities

• Proven leadership in regulatory compliance and cross-functional program management
• Strong understanding of CMS and state adequacy requirements
• Experience with provider data systems, master data management, and data governance
• Excellent communication and stakeholder engagement skills
• Ability to manage vendor relationships and evaluate technology solutions

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, Madison, WI, Omaha, NE, or St. Louis, MO.

The full salary grade for this position is $111,200 - $190,600. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $111,200 - $166,740. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data.  In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US:
Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.