Magellan Health
Network Management Specialist (Finance)
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.
- Partners with quality improvement in identifying and reporting trends, and identifying areas for improvement.
- Provides team leadership on network projects. Assures accurate and timely delivery of field network projects as assigned.
General Job Information
Title
Network Management SpecialistGrade
20Job Family
Operations GroupCountry
United States of AmericaFLSA Status
United States of America (Exempt)Recruiting Start Date
1/16/2020Date Requisition Created
1/16/2020Work Experience
NetworkEducation
BachelorsLicense and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
Responsibilities
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 presentations skills using PowerPoint.
Minimum of 3 years experience in related position/field.
Previous experience in a network development, provider recruitment or provider contracting.
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.