Network Operational Specialist

Exempt

GENERAL DESCRIPTION:

Responsible for identifying, analyzing, and implementing impactful health services network management initiatives focused on enhancing service quality, driving process improvements, and ensuring contractual compliance. Translates strategic plans into actionable initiatives, effectively operationalizing them across the healthcare network. Collaborates cross-functionally with other departments to ensure alignment with organizational objectives and regulatory standards.

ESSENTIAL FUNCTIONS:

• Support the evaluation and end-to-end implementation of network initiatives, including market assessments, network management strategies, and operational efficiency plans aligned with organizational goals.
• Evaluate provider initiatives related to credentialing, contracting, compensation, and corporate operations, offering data-driven recommendations to enhance performance and compliance.
• Review utilization and performance reports of providers and networks, contributing to the development and execution of continuous improvement action plans.
• Design and prepare comprehensive reports and presentations that communicate departmental objectives and network initiatives, ensuring alignment among operational and compliance stakeholders.
• Collect and synthesize analytical data to effectively document and present proposed initiatives to management.
• Monitor and document the progress of strategic initiatives throughout all phases, supporting successful implementation across the network.
• Actively participate in cross-functional meetings with internal departments to foster collaboration and ensure alignment with network initiatives.
• Support the creation and maintenance of regulatory documentation compliant with federal, state, and organizational requirements.
• Collaborate with internal teams to facilitate timely resolution of health service issues, quality improvement efforts, and member satisfaction initiatives.
• Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
• May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.

Education and Experience: Bachelor’s Degree in Business Administration, Public Health, Health Services Administration, or related areas. At least two (2) years of experience in healthcare compliance or operational process optimization within complex, highly regulated healthcare insurance environments, applying structured problem-solving, root cause analysis, and continuous improvement methodologies to enhance operational effectiveness.

“Proven experience may be replaced by previously established requirements.”

Certifications / Licenses: Not required.

Other: N/A

Languages:

Spanish – Advanced (comprehensive, writing and verbal)

English – Advanced (comprehensive, writing and verbal)

“We are an Equal Employment Opportunity Employer and take Affirmative Action to recruit Protected Veterans and Individuals with Disabilities.”