RN Provider Support Consultant

Richmond VA 23233

Job Description

We are seeking a Provider Support Consultant who will work in the Richmond office and this position will also require up to 50% 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.

Essential Functions

  • 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


RN Provider Support Consultant



Job Family

Clinical Services Group


United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date


Date Requisition Created


Work Experience

Managed Healthcare, Quality


Bachelors: Healthcare (Required), Bachelors: Nursing (Required), Bachelors: Social Work, Masters

License and Certifications - Required

LAC - Licensed Associate Counselor - Care Mgmt, LCSW - Licensed Clinical Social Worker - Care Mgmt, LMFT - Licensed Marital and Family Therapist - Care Mgmt, PSY - Psychologist - Care Mgmt, QMHP - Qualified Mental Health Professional - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt

License and Certifications - Preferred

CPHQ - Certified Professional In Healthcare Quality - Care Mgmt

Other Job Requirements


Preferred Qualifications

  • 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 

Required Qualifications

  • 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. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

“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.”

Haita Makanji VP of Clinical Strategy and Programs at Magellan MRx