Job DescriptionResponsible for the implementation and support of all activities related to developing and maintaining service provider contracts. Interacts with all areas of the Magellan organization to coordinate network management and network administration responsibilities and facilitates resolution of contract issues, obtains legal review and approval of working changes in contract documents. This position is responsible for monitoring provider contract compliance and for development of performance based contract incentives.
Responsible for facilitation of CARTs, Special Projects, Participate in Special Investigations Unit (SIU) provider research, Network Development in assigned regions, DMHC Regulatory Requests responses, ACO Reporting, Provider Network Data Validation, and Provider Handbook Review and Edits Annually.
- Negotiates contracts and amendments with facilities, organizational and/or large group providers, as well as independent practitioners.
- Works with other departments as needed for timely completion of annual amendment cycles from beginning to end.
- Manages annual re-contracting efforts across departments.
- Manages the process to address provider requests for contract modification.
- Minimizes situations where retro-active contract modifications are required.
- When retro-active implementation is necessary, utilizes streamlined approach to obtain approvals, providing thorough communication to approvers regarding the reason for delay.
- Monitors ongoing provider performance changes in cost and utilization needs.
- Develops and maintains professional working relationships with providers.
- Analyzes contract modification requests and coordinates with the Finance Department on financial impact of any rate/ funding changes.
- Develops and implements process for monitoring provider contract compliance and performance-based contract incentives.
- Identifies and implements process improvements to the contract/amendment process as needed.
- Ensures that contracts are system compatible, loaded correctly, timely and meet legal and business standards.
- Ensures contracts audits are accurate and on time.
- Develops and maintains professional working relationship with providers.
- 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
- Provides issue resolution and complex trouble shooting for providers.
- Conducts provider education and provider relation activities, providing necessary written materials.
General Job Information
TitleProvider Contract and Outreach Manager
Job FamilyOperations Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date7/1/2019
Date Requisition Created7/1/2019
Work ExperienceFinance, Project/Program Management, Public Health
License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
- A minimum of 5 years of progressively more responsible public or commercial health plan sector health care administration experience in contract administration.
- Demonstrated advanced experience with public sector financial/contractual analysis and negotiations including risk arrangements.
-Awareness of and/or experience with trends toward contracting integrated healthcare networks.
- Critical thinker.
- Self-motivated and a team player.
- 5 years of direct experience in lieu of degree.
Demonstrated proficiency of healthcare provider data and information.
• Project management experience.
• Strong preference for managed care contracting experience.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.