Network Management Specialist at Magellan Health Services inc in Newtown, Pennsylvania

Job Description:

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.

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 1 year experience in related position/field., Previous experience in a network development, provider recruitment or provider contracting.

General Job Information

Title
Network Management Specialist

Grade
20

Work Experience - Required
Network

Work Experience - Preferred

Education - Required

Education - Preferred
Bachelors

License and Certifications - Required

License and Certifications - Preferred

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.