Network Management Specialist

Magellan Health; Albuquerque (NM); On-site; USD 46,000 - 68,000; Full time

Benefits offered by this job

Health benefits

Life insurance

Voluntary benefits

Job summary

Magellan Health in Albuquerque, NM seeks a Network Management Specialist to support development and maintenance of the physician, practitioner, group, and facility network for MPPS and organization services.

You will coordinate network management, assess needs, recruit providers, conduct contracting, provide provider education, and perform audits for compliance with Magellan policies across multiple customers.

Qualifications

• Knowledge of NCQA requirements.
• Ability to work independently and prioritize activities.
• Intermediate knowledge of Microsoft Office Suite, specifically Excel.
• Strong presentations skills using PowerPoint.

Responsibilities

• Support development and maintenance of provider networks (physician, practitioner, group, facility) for MPPS and organization services.
• Coordinate network management and network administration responsibilities with multiple stakeholders.
• Recruit providers to meet network adequacy standards and ensure quality.
• Conduct provider education, site visits, and reporting to meet contractual requirements.

Skills

NCQA knowledge

Independent work style

Excel

PowerPoint

Education

GED or High School

Bachelor's (preferred)

Tools

Microsoft Office Suite

Job description

Job Summary

This position is responsible for the support of all activities related to developing and maintaining the physician, practitioner, group, and/or facility, MPPS and organization services delivery system in small to mid-size market defined by membership, number of providers in delivery system, number of business operating units and lines of business. Interacts with all areas of organization to coordinate network management and network administration responsibilities. Assesses network needs, analyzes network composition, and using organization databases, application of regulatory requirements, accreditation entities and other resources, recruits individual, group and/or organizational providers to meet network adequacy standards and assure quality network. Conducts and coordinates contracting and amendment initiatives. Provides issue resolution and complex trouble shooting for providers. Conducts provider education and provider relation activities, providing necessary written materials. Conducts administrative provider site visits and coordinates report development and completion according to contractual requirements or ad hoc requests. Coordinates Public Policy Research Center (PPRC) activities to assure maintenance of current credentialing status, and evaluation and appropriate actions of quality of care issues and complaints against providers. Conducts and manages ongoing audits of provider compliance with Magellan policies and procedures as well as contractual obligations for multiple customers. Develops work plans to address audit requirements. Works with management to draft, clarify and recommend changes to policies which impact network management. The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description.

Other Job Requirements Responsibilities

• Knowledge of National Committee for Quality Assurance (NCQA) requirements.
• Ability to work independently and prioritize activities.
• Intermediate knowledge of Microsoft Office Suite, specifically Excel.
• Strong presentations skills using PowerPoint.
• Minimum of 1 year experience in related position/field.

General Job Information

• Title Network Management Specialist
• Grade 21
• Work Experience - Required
• Network Work Experience - Preferred
• Education - Required: GED, High School Education
• Education - Preferred: Bachelor's
• License and Certifications - Required
• License and Certifications - Preferred
• Salary Range
• Salary Minimum: $45,655 Salary Maximum: $68,485

Benefits and Perks

• Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.

Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

Magellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live. Our strong culture of caring is the common thread in both our business strategy and our work environment. We value professional growth and development, total health and wellness, rewards and recognition as well as employee unity. Magellan is a place where you can thrive.

Magellan is committed to providing equal employment opportunities to employees and applicants for employment without regard to race, color, creed, religion, sex, gender identity and expression, sexual orientation, marital status, age, national origin, ancestry, citizenship, physical or mental disability, disabled veteran or veteran of the Vietnam Era status, or any other factors protected by law.

Magellan is committed to meeting applicable Federal labor and employment law posting requirements by providing necessary posters in a format which is easily accessible and conspicuous to all applicants. Copies of applicable posters are accessible by clicking here.