Network Management Specialist - Albuquerque, NM

VetJobs; Albuquerque (NM); On-site; USD 45,000 - 69,000; Full time

Job summary

VetJobs is seeking a Network Management Specialist to support the development and maintenance of healthcare networks. This role focuses on contracting providers and ensuring network adequacy in a military-friendly environment. Ideal candidates include veterans and military spouses with experience in network management.

Benefits

Comprehensive benefits package

Eligibility for short-term incentives

Qualifications

• Minimum of 1 year experience in related position/field.
• Strong presentations skills.
• Ability to prioritize activities.

Responsibilities

• Responsible for contracting providers.
• Analyze network composition and recruit providers.
• Conduct and manage audits of provider compliance.

Skills

Knowledge of NCQA requirements

Ability to work independently

Intermediate knowledge of Microsoft Office Suite

Presentation skills using PowerPoint

Education

High School/GED

Bachelor's degree (preferred)

Tools

Microsoft Excel

Job description

16 hours ago Be among the first 25 applicants

Job Description

Job Description

ATTENTION MILITARY AFFILIATED JOB SEEKERS - Our organization works with partner companies to source qualified talent for their open roles. The following position is available to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers. If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps. Unless specifically stated otherwise, this role is "On-Site" at the location detailed in the job post.

Responsible for contracting providers.

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.

Auto req ID

447294BR

Minimum Education Required

High School/GED

Job_Category

Network

Additional Qualifications/Responsibilities

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

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.

City*

Albuquerque

State*

New Mexico

Job Code

Social_ Worker

Affiliate Sponsor

Magellan Federal - AFSC

Salary Range

$45,000-$60,000

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Information Technology

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