Network Management Specialist

Magellan Health; Newtown (CT); On-site; USD 46,000 - 68,000; Full time

Benefits offered by this job

Short-term incentives

Comprehensive benefits

Job summary

Magellan Health in Newtown, CT is seeking a Network Management Specialist to develop and maintain the provider network across physician, practitioner, group and facility entities. You will coordinate network management responsibilities and collaborate with multiple areas of the organization to ensure quality and regulatory compliance.

Responsibilities include provider education, site visits, contract management, and coordinating audits to align with Magellan policies and contractual obligations.

Qualifications

• Knowledge of NCQA requirements.
• Ability to work independently and prioritize activities.
• Intermediate knowledge of Microsoft Office Excel.
• Strong PowerPoint presentation skills.
• Minimum of 1 year experience in related position/field.

Responsibilities

• Assess network needs and recruit providers to meet network adequacy standards.
• Conduct contracting and amendment initiatives.
• Provide issue resolution and complex troubleshooting for providers.
• Coordinate provider education and provider relations activities.
• Conduct provider site visits and coordinate report development per contractual requirements.

Skills

Independent work

Prioritization

Presentation skills

Education

GED or High School

Bachelor’s degree preferred

Tools

Microsoft Excel

PowerPoint

Job description

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.

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

Education - Required

GED, High School

Education - Preferred

Bachelor’s

Salary Range

Salary Minimum:

$45,655

Salary Maximum:

$68,485

This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual’s skills, experience, education, and other job-related factors permitted by law.

This position may be eligible for short-term incentives as well as a comprehensive benefits package. 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.