Network Regulatory Specialist

About the role

The Network Regulatory Specialist supports regulatory compliance through audit readiness, regulatory reviews, corrective‑action plan management, and monitoring of provider network activities such as contracting, credentialing and re‑credentialing. The role works closely with cross‑functional teams to prepare documentation, resolve issues and drive continuous improvement in Network Management.

Key responsibilities

• Serve as the primary liaison between Network Management and Compliance to coordinate communication, assessment and operational implementation of regulatory, accreditation and contractual requirements.
• Evaluate regulatory, accreditation and business requirement changes, conduct impact assessments and coordinate readiness activities for timely implementation.
• Identify, assess and monitor operational, regulatory and process risks within network activities and recommend mitigation strategies.
• Prepare and present risk assessments, readiness status updates, corrective‑action progress and operational findings to leadership and internal stakeholders.
• Facilitate development, implementation and monitoring of corrective‑action plans resulting from audits, regulatory reviews and internal assessments.
• Develop, maintain and analyze dashboards, scorecards, KPIs and operational metrics to identify trends and support compliance‑related decision making.
• Monitor credentialing, re‑credentialing and provider contracting metrics to spot compliance risks, process gaps and improvement opportunities.
• Coordinate audit‑readiness initiatives by maintaining documentation, evidence repositories and process inventories required for regulatory reviews and accreditation activities.

Required profile

• Bachelor’s degree in Business Administration, Health Services Administration, Public Health or a related field.
• At least two years of experience in healthcare regulatory compliance, network management, provider operations, quality management, audit management or related functions, preferably within the health‑insurance industry.
• Advanced proficiency in English (written and verbal).
• Advanced proficiency in Spanish (written and verbal).