Albuquerque NM 87113
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.
- Negotiates contracts and amendments with Public Network Operators (PNOs), Qualified Service Providers (QSPs), 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.
- Provides oversight to the Prospective Provider and SCA processes.
- Manages the Primary Care Management Module (PCMM) and Rates Governance 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.
- Provides supervision/performance management to team of contract coordinators.
- Works in concert with other teams to respond to changing or emerging system initiatives; actively participates in RFP re-bid processes as needed.
General Job Information
Job FamilyLegal Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date8/23/2019
Date Requisition Created8/21/2019
Work ExperienceContract Administration and Management, Network
EducationA Combination of Education and Work Experience May Be Considered., Bachelors
License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
- For roles supporting MRx, a Pharmacy Technician (either CPT/LPT/PTCB/RPT based on State Requirements) preferred.
- Demonstrated proficiency of pharmacy data and information.
- Project management experience.
- Strong preference for managed care contracting experience.
- A minimum of 5 years of progressively more responsible public 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.
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.
Top 5 reasons to work at Magellan
Meaningful Work With People Who Care
At Magellan Health you can do meaningful work and feel confident that you matter in an organization that makes a real difference in the world - one that cares deeply and uses its employees’ collective insight as a competitive advantage.Read More
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