Network Management Specialist

Albuquerque NM 87113

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.

Essential Functions


- 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.

General Job Information

Title

Network Management Specialist

Grade

20

Job Family

Operations Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

7/22/2019

Date Requisition Created

7/22/2019

Work Experience

Network

Education

Bachelors

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements

Responsibilities

Knowledge of armed services programs and previous provider recruitment and relations experience. Excellent communication and negotiation skills. Intermediate MS Office Suite working knowledge. Proof of US Citizenship required.

5+ years network or provider relations 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.