Magellanhealth · RemotePrepare for this interview
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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. - Partners with quality improvement in identifying and reporting trends, and identifying areas for improvement. - Provides team leadership on network projects. Assures accurate and timely delivery of field network projects as assigned. The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description. Other Job Requirements
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