Network Management Specialist

Magellan Health; United States; Remote; USD 45,000 - 69,000; Full time

Job summary

An established industry player seeks a Network Management Specialist to enhance their physician and provider network. This role involves assessing network needs, recruiting providers, and ensuring compliance with quality standards. You will work independently to analyze network composition and conduct provider education, while also coordinating audits and policy recommendations. Join a forward-thinking organization that values your contributions and offers a comprehensive benefits package to support your wellbeing. If you have a passion for network management and quality assurance, this opportunity is perfect for you.

Benefits

Comprehensive benefits package

Short-term incentives

Health and life insurance

Voluntary benefits

Qualifications

• Minimum of 1 year experience in a related position/field.
• Knowledge of NCQA requirements is essential.

Responsibilities

• Assess network needs and analyze network composition for adequacy.
• Conduct provider education and manage compliance audits.

Skills

Knowledge of NCQA requirements

Ability to work independently

Intermediate knowledge of Microsoft Office Suite

Strong presentation skills

Education

Bachelor's degree

Tools

Microsoft Excel

Microsoft 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.

Key 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.

Other Job Requirements

Required Knowledge and Skills:

• 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 presentation 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:

Education - Preferred: Bachelor's

License and Certifications - Required:

License and Certifications - Preferred:

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.