Network Management Specialist

🔥 5 minutes ago

🇺🇸 United States – Remote

💵 $45.7k - $68.5k / year

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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Magellan Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

💰 $101M Private Equity Round - Magellan Health Services on 2004-01

Healthcare • Healthcare Insurance

Magellan Health is a healthcare organization focused on behavioral health and care-management services. The company provides clinical care managers, military and family life counselors, and behavioral health services across regional programs (e. g. , Magellan Hawai‘i, Magellan of New Mexico), and supports treatment coordination for mental health and substance abuse conditions. It also offers programs that support military families and other institutional clients, indicating work in managed behavioral health and care coordination.

📋 Description

• Support activities related to developing and maintaining physician, practitioner, group, facility, MPPS, and organization services 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 • Provide issue resolution and complex troubleshooting for providers • Conduct provider education and provider relations activities • Conduct administrative provider site visits and coordinate report development and completion • Coordinate PPRC activities to maintain credentialing status and address quality-of-care issues and provider complaints • Manage ongoing audits of provider compliance with Magellan policies, procedures, and contractual obligations • Develop work plans to address audit requirements • Work with management to draft, clarify, and recommend policy changes impacting network management • Perform additional duties aligned with the intent of the role as assigned

🎯 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 a related position/field • Required education: GED or high school • Must comply with applicable legal, regulatory, contractual, and internal policy requirements • Must understand, comply with, and attest to position-specific security responsibilities and controls

🏖️ 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