Job DescriptionThe Provider Support Consultant will work remotely once training is completed (after about 30 days), but will need to come into the Richmond, VA office 1-2 days per week or more as needed. This position also requires travel throughout the state of Virginia.
The Provider Support Consultant acts as the front-line liaison between the health plan and provider offices to build and nurture positive provider relationships and improve quality of care for members. He/she provides education and provides support to high volume clinics and providers. He/she is implements field and provider practice-based quality initiatives and programs, completes medical record reviews, and maintains relationships with providers and clinics to improve upon existing services offered by providers. He/she works both internally and externally to help ensure improved population health of our members.
- Collaborates with contracted providers and delegated provider groups to implement system changes, develop processes and support other program development activities.
- Assesses current practice patterns, assets and challenges utilizing NCQA, HEDIS, state and regulatory standards.
- Conducts provider office assessments and evaluates results of the initial assessment to determine needs and opportunities for collaboration.
- In provider office, schedules members for appointments to close HEDIS gaps in care and for follow-up after hospitalization.
- Establishes a project plan with the practice that establishes goals and objectives for improvement.
- Develops protocol for staff placed in provider offices including policies and procedures.
- Ensures staff onsite in provider offices properly represent Magellan Complete Care (MCC) and follow the polices and procedures set forth by the health plan.
- Provides ongoing practice support and sustains the partnership by establishing regular meetings to track progress; provides orientation, training, education meetings, presentations and focus groups to improve mutual understanding and enhance working partnerships with providers.
- Improves member experience to positively impact CAHPS scores.
- Improves the understanding and sensitivity to the unique needs of MCC’s population and care givers.
- Schedules members for appointments as sites allow.
- Evaluates program for barriers and opportunities and make changes as appropriate.
- Provides on-site support in provider offices for the completion of clinical interventions.
- Coordinates community engagement activities to help improve member compliance.
- Multi-departmental collaboration for member and provider outreach activities.
- Performs other duties and projects as assigned.
General Job Information
TitleProvider Support Consultant
Job FamilyClinical Services Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date2/11/2019
Date Requisition Created2/5/2019
EducationBachelors: Healthcare (Required), Bachelors: Nursing (Required), Bachelors: Social Work, Masters
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
- Master’s degree in related discipline or equivalent work experience
- Demonstrated experience in leading significant cross-functional work
- Excellent knowledge of HEDIS, NCQA, Medicare Stars and Medicaid
- Ability to create innovative campaigns for various HEDIS and NCQA measures
- Conceptual and in-depth knowledge of the healthcare industry
- Ability to manage relationships with an emphasis on internal and external mid-level relationships
- Ability to work across all levels of the organization, including working with executive audiences, vendors and the government as a customer
- Demonstrated ability to select and implement strategies that are most likely to be successful
- Minimum three years experience in managed care
- Registered Nurse or appropriate clinical licensure
- Bachelor’s degree in healthcare or related discipline
- Three plus years of experience in quality management
- Demonstrated understanding of healthcare industry standards, HEDIS and NCQA
- Proficient in Microsoft Office tools
- Strong analytical skills and strategic thinking
- Strong communication skills, both verbally and written
- Experience working with providers
- Ability to interact effectively with business owners, senior management, and peers across the organization
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.”