Network Management Specialist
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Job Description
Network Management Specialist maintaining provider networks and recruiting providers for Magellan Health. Managing contracts, audits, credentialing, compliance, and provider relations.
Responsibilities:
- Support activities related to developing and maintaining physician, practitioner, group, facility, MPPS and organization service delivery systems
- Interact with organizational areas to coordinate network management and administration responsibilities
- Assess network needs and analyze network composition
- Recruit providers to meet network adequacy standards and assure network quality
- Conduct and coordinate contracting and amendment initiatives
- Resolve complex provider issues and troubleshooting
- Conduct provider education and provider relations activities
- Conduct administrative provider site visits and coordinate report development
- Coordinate PPRC activities related to credentialing status and quality-of-care issues and complaints
- Manage ongoing audits of provider compliance with Magellan policies, procedures and contractual obligations
- Develop work plans to address audit requirements
- Draft, clarify and recommend policy changes affecting network management
Requirements:
- Knowledge of National Committee for Quality Assurance (NCQA) requirements
- Ability to work independently and prioritize activities
- Intermediate knowledge of Microsoft Office Suite, specifically Excel
- Strong presentation skills using PowerPoint
- Minimum of 1 year experience in related position/field
- GED or high school education required
- Compliance with security responsibilities, security controls, legal, regulatory, contractual and internal policy requirements
- Bachelor’s education preferred
Benefits:
- Short-term incentives may be available
- Comprehensive benefits package
- Health, life, voluntary and other benefits
- Benefits and perks supporting physical, mental, emotional and financial wellbeing
- Tobacco-free workplace
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