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.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.The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description.Other Job RequirementsResponsibilitiesKnowledge of National Committee for Quality Assurance (NCQA) requirements.Ability to work independently and prioritize activities.Intermediate knowledge of Microsoft Office Suite, specifically Excel.Strong presentations skills using PowerPoint.Minimum of 1 year experience in related position/field.General Job InformationTitleNetwork Management SpecialistGrade21Work
Experience - RequiredNetworkWork
Experience - PreferredEducation - RequiredGED, High SchoolEducation - PreferredBachelor'sLicense and Certifications - RequiredLicense and Certifications - PreferredSalary RangeSalary Minimum:$45,655Salary Maximum:$68,485This information reflects the anticipated base salary range for this position based on current national data.
Minimums and maximums may vary based on location.
Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.This position may be eligible for short-term incentives as well as a comprehensive benefits package.
Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.Originally posted on Himalayas
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