Network Management Specialist - Medical - Baton Rouge LA

About the role

This position supports 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 markets. Responsibilities include coordinating network management and administration, assessing network needs, recruiting providers, conducting trouble shooting, and managing audits.

Responsibilities

• Interacts with all areas of the organization to coordinate network management and network administration responsibilities.
• Assesses network needs, analyzes network composition, and recruits providers to meet network adequacy standards.
• 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.
• Coordinates Public Policy Research Center (PPRC) activities to maintain current credentialing status and evaluate quality of care issues.
• Conducts and manages ongoing audits of provider compliance with Magellan policies and procedures.
• Develops work plans to address audit requirements.
• Works with management to draft, clarify, and recommend changes to policies impacting network management.

Requirements

Knowledge of NCQA requirements, independent work ability, intermediate Microsoft Office Suite skills, strong presentation skills, and one year of related experience are required. Bachelor’s degree is preferred but not required.

Qualifications

• High school diploma or equivalent.
• Bachelor’s degree preferred.

Skills

Intermediate knowledge of Microsoft Office Suite, specifically Excel, strong presentations skills using PowerPoint, and knowledge of NCQA requirements are essential.

Benefits

N/A

Pay

$45,655 - $68,485 annually

Schedule

N/A