Network Management Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Assist in the development and maintenance of service delivery systems for physicians, practitioners, groups, facilities, MPPS, and organizations.

• Collaborate with various organizational departments to manage network administration and responsibilities.

• Evaluate network requirements and analyze the composition of the network.

• Recruit providers to ensure compliance with network adequacy standards and maintain network quality.

• Lead and coordinate initiatives related to contracting and amendments.

• Provide resolution for issues and complex troubleshooting for providers.

• Facilitate provider education and maintain positive provider relations.

• Carry out administrative site visits for providers and oversee the development and completion of reports.

• Organize PPRC activities to uphold credentialing status and tackle quality-of-care concerns and provider complaints.

• Oversee continuous audits of provider adherence to Magellan's policies, procedures, and contractual obligations.

• Create work plans to meet audit requirements.

• Collaborate with management to draft, clarify, and propose policy modifications that affect network management.

• Perform additional duties relevant to the role as assigned.

⛳️ Requirements

• Familiarity with the National Committee for Quality Assurance (NCQA) standards.

• Ability to work autonomously and prioritize tasks effectively.

• Intermediate proficiency in Microsoft Office Suite, particularly Excel.

• Excellent presentation skills utilizing PowerPoint.

• At least 1 year of experience in a related role or field.

• Required education: GED or high school diploma.

• Must adhere to relevant legal, regulatory, contractual, and internal policy requirements.

• Must comprehend, comply with, and affirm position-specific security responsibilities and controls.

🏝️ Benefits

• Short-term incentives may be available.

• A comprehensive benefits package is provided.

• Health, life, voluntary, and additional benefits.

• Benefits and perks that support physical, mental, emotional, and financial well-being.

• A tobacco-free workplace.