Network Management Specialist - New Mexico Resident

About the role

This position is remote, but must be located in New Mexico. The Network Management Specialist supports the development and maintenance of the 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 provider education, and managing audits.

Responsibilities

• Interacts with all areas of the organization to coordinate network management and administration.
• Assesses network needs and analyzes network composition, using organization databases, regulatory requirements, accreditation entities, and other resources.
• Recruits individual, group, and organizational providers to meet network adequacy standards and ensure quality network.
• Conducts and coordinates contracting and amendment initiatives.
• Provides issue resolution and complex trouble-shooting for providers.
• Conducts provider education and maintains provider relations, providing necessary written materials.
• Coordinates Public Policy Research Center (PPRC) activities to maintain current credentialing status and evaluate 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 impacting network management.

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 of experience in a related position or field.

Qualifications

• GED, High School Education.
• Bachelor's Degree.

Skills

• Microsoft Office Suite proficiency, particularly Excel.
• Strong presentation skills using PowerPoint.
• Ability to work independently and prioritize tasks.

Benefits

The position offers a comprehensive benefits package including health, life, voluntary, and other benefits designed to enhance physical, mental, emotional, and financial wellbeing. Magellan is committed to being an equal opportunity employer and a tobacco-free workplace.

Pay

The salary range for this position is $45,655 to $68,485, with actual pay adjusted based on individual qualifications, experience, and other job-related factors permitted by law. Short-term incentives may also be available.

Schedule

The position is remote, but requires the ability to work in New Mexico.