Curana Health is a provider of value-based primary care services for the senior living industry, including skilled nursing facilities, assisted & independent living communities, Memory Care units, and affordable senior housing sites. Our 1,000+ clinicians serve more than1,500 senior living community partners across 33 states, and Curana participates in various innovative CMS programs (including owned-and-operated Accountable Care Organizations and Medicare Advantage plans). With rapid year-over-year growth since our founding in 2021, Curana is setting a new standard in innovative care delivery for seniors with high-risk, complex clinical needs, many of whom have been historically underserved by the health care system. Our mission: To radically improve the health, happiness and dignity of senior living residents.
Job Summary:
Curana’s Provider Network Management team is looking for an enthusiastic and motivated individual to fill the critical role of Provider Network Analyst. As an Analyst, you will play a vital role in building and maintaining a robust provider network and ensuring the accuracy of provider information. Your expertise will be utilized to help identify network gaps, support contracting efforts, and implement necessary updates to support our Provider Network Management operations.
Responsibilities:
- Serve as the Subject Matter Expert (SME) for designated plan networks, providing guidance to Network Contractors and Health Plan Account Managers on network adequacy status, network gaps, contracting targets, and data quality issues.
- Analyze provider data and generate ongoing dashboard reports to assess provider network adequacy consistent with the Centers for Medicare and Medicaid (CMS) HSD requirements.
- Report on aged gaps, new gaps and contracting efforts for assigned plans.
- Review network data for accuracy and facilitate necessary updates.
- Collaborate with Network Contractors to identify target physicians for gap resolution, developing action plans as needed.
- Create and maintain network adequacy ad-hoc reports for provider network expansions, as necessary.
- Utilize third-party vendor Cloud tools to monitor and update provider networks, ensuring data accuracy and completeness.
- Gather data from primary and secondary sources, maintaining our databases and data systems.
- Proactively identify and define process improvement opportunities.
- Support network expansion plan recruitment and contracting efforts.
- Review large provider roster loads, ensuring accuracy and compliance with credentialing and delegation information.
- Coordinate network submissions to CMS, ensuring file quality checks are passed.
- Maintain plan HSD tables to CMS standards, actively researching and addressing data discrepancies.
- Actively participate in new provider data enhancement implementations and User Acceptance Testing (UAT), serving as the SME for network data.
- Collaborate with management to prioritize business and information needs.
- Perform additional duties as assigned by our Provider Network Management leadership team.
Knowledge & Skills Required:
- Associate Degree in Information Technology, Computer Science, Business Management, or a related field (Bachelor’s Degree preferred).
- 2-5 years of experience in provider network requirements and provider data within a Managed Care environment and payor organization is preferred.
- Experience in conducting research and analysis to identify network gaps/needs is preferred.
- Strong understanding of Microsoft Excel and Microsoft Access tools is essential. Exposure to MS SharePoint, MS PowerApps, and MS Power Automation will be considered a strong advantage.
- Ability to work with multiple data sets across systems.
- Strong analytical skills with a keen attention to detail and accuracy.
- Ability to work independently and strategically, with a high degree of flexibility.
- Eager to work efficiently and effectively in a fast-paced environment.
Curana Health is dedicated to the principles of Equal Employment Opportunity. We affirm, in policy and practice, our commitment to diversity. We do not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable or state law, genetic information, or any other characteristic protected by applicable federal, state and local laws and ordinances.
The EEO policy applies to all personnel matters as outlined in our company policy including recruitment, hiring, transfers, and general treatment during employment.
