Job DescriptionImplements programs to build and nurture positive provider relationships and improve the quality of care for enrollees. Provides education and support including orientation to the plan, facilitation of best practices to improve provider processes, and quality and practice guidelines. Collaborates with internal departments to assist with strategies related to the development and management of the provider network. Responds to provider issues, problem-solves with internal clinical, operations and other stakeholders to achieve positive outcomes and improve workflows. Works with the Quality Department to implement field and provider practice based quality initiatives and programs, medical record reviews, and interfaces with HEDIS vendor in the field. Assesses practice readiness for working with SPMI (Serious and Persistent Mental Illness) members and supports provider practices using a broad set of tools, resources and reports.
- Provides orientation, training, education meetings, presentations, and focus groups to improve mutual understanding and enhance working partnerships with providers.
- Works with provider groups to improve quality, outcomes and efficiency and to adopt best practices.
- Assists with brokering the relationship between BH and PH providers.
- Works with our providers to transform data into actionable information at the practice and member level e.g. gaps in care, quality and utilization, etc.
- Offers basic trainings and webinars for providers and office staff re: SPMI population co-occurring disorders, stigma, poverty, disparities, substance abuse, reduce discrimination.
- Performs medical record reviews as needed.
- Responds to provider inquiries via phone, e-mail, secure web messaging.
- Supports processes that address provider complaints, claims, contracting, credentialing and other problems requiring follow-up and resolution.
- Facilitates immediate resolution of red-flag provider issues that are client, community, legal, or contractual threats with internal personnel as needed.
- Assists in development and management of weekly, monthly, quarterly reports.
- Other duties as assigned.
General Job Information
TitleProvider Support Specialist
Job FamilyClinical Services Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date12/6/2018
Date Requisition Created11/29/2018
EducationBachelors: Nursing (Required), Masters: Behavioral Health (Required)
License and Certifications - RequiredLAC - Licensed Associate Counselor - Care Mgmt, LCSW - Licensed Clinical Social Worker - Care Mgmt, LMFT - Licensed Marital and Family Therapist - Care Mgmt, PSY - Psychologist - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt
License and Certifications - PreferredCPHQ - Certified Professional In Healthcare Quality - Care Mgmt
Other Job Requirements
- 5+ in a Healthcare environment.
- Ability to travel regionally 60-75% in field.
- Masters level licensed Registered Nurse (RN).
- Strong knowledge of Medicaid.
- Experience with practice facilitation or provider relations.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled
“I receive a high level of support from our Senior Management Team to execute on our vision. They are always accessible and approachable, something I’ve found to be very unique to Magellan.”