- 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.
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provider liaison
1 week ago
Magellan Health Services Albuquerque, NM , USA, United StatesThis 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 deliv ...
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Provider Relations Liaison
1 day ago
Magellan Health Albuquerque, United States Full timeThis 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 deliv ...
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native american health services specialist
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University of New Mexico Albuquerque, United States*Cell phone and/or smart devices are not allowed on persons for this position at MDC, unless there is a documented medical condition. · *Additional $6.00/HR Safety Incentive Increase · Department: MDC - Medical · FTE: 1.00 · Full Time · Shift: Days · UNM Hospital is the new ...
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rn - inpatient supervisor
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rn - surgical specialties - casual pool
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cwa - tech mental health i
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Workers' Compensation Coordinator
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College of the Canyons Valencia, United States**Description**: · The Santa Clarita Community College District/College of the Canyons is seeking a** full-time Workers' Compensation Coordinator in the Human Resources Department.** · Reporting to and under the supervision of the Director, Recruitment and Employee Services, the ...
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Travel Occupational Therapist
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Host Healthcare Albuquerque, NM, United StatesHost Healthcare is seeking a travel Occupational Therapist for a travel job in Albuquerque, New Mexico. · Job Description & Requirements · Specialty: Occupational Therapist · Discipline: Therapy · Start Date: 06/01/2024 · Duration: 12 weeks · 40 hours per week · Shift: 8 hours, d ...
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Travel Nurse RN
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Travel Nurse RN
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Travel Echo-Vascular Technician
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Travel Physical Therapist
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Travel CT Technologist
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Travel Physical Therapist
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Travel Physical Therapist
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Dietitian Nutritionist I
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Travel Nurse RN
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Travel Nurse RN
9 hours ago
MedPro Healthcare Staffing Albuquerque, NM, United StatesMedPro Healthcare Staffing is seeking a travel nurse RN PCU - Progressive Care Unit for a travel nursing job in Albuquerque, New Mexico. · Job Description & Requirements · Specialty: PCU - Progressive Care Unit · Discipline: RN · Start Date: 05/28/2024 · Duration: 13 weeks · 36 h ...
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Clinic Director
6 days ago
ATI Physical Therapy Albuquerque, United StatesOverview: · Physical Therapists must be licensed or license-eligible in the state to which they are applying. · This is a management role where you will be responsible for the day-to-day operations of the clinic, supervision of clinic staff as well as patient treatment. The Clin ...
Provider Liaison - Albuquerque, United States - Magellan Health
Description
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.Other Job Requirements
Responsibilities
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 presentations skills using PowerPoint.
Minimum of 1 year experience in related position/field.
General Job Information
Title
Provider LiaisonGrade
21Work Experience - Required
NetworkWork Experience - Preferred
Education - Required
Education - Preferred
Bachelor'sLicense and Certifications - Required
License and Certifications - Preferred
Salary Range
Salary Minimum:
$45,655Salary Maximum:
$68,485This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.
This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
