Network Optimization Principal

The Network Optimization Principal will lead the strategic development and maintenance of Illinois Medicaid and LTSS plan’s provider network, driving optimization and value while ensuring compliance with contractual requirements. Responsibilities include analyzing provider network performance, partnering with Provider Relations, advising on network composition and value-based payment strategy, defining and executing network development strategy, maintaining network development plans, acting as a subject matter expert on Illinois contractual requirements, analyzing data and market intelligence, monitoring network adequacy, identifying and closing access gaps, managing provider data accuracy, overseeing contracting campaigns, collaborating with clinical and UM teams to address access issues, managing network assessments, resolving root causes of inaccuracies, ensuring state submissions, monitoring terminations, overseeing member and provider communications, developing tracking systems, managing rate approvals, setting strategy for value-based payment programs, leading VBP governance forums, identifying trend-bender opportunities, providing market oversight for VBP models, monitoring performance against KPIs, and participating in operating meetings with key providers.