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    Network Management Specialist - Boise, United States - Idaho State Job Bank

    Idaho State Job Bank
    Idaho State Job Bank Boise, United States

    3 weeks ago

    Idaho State Job Bank background
    Description


    Network Management Specialist at Magellan Health Services in Boise, Idaho, United States Job 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.

    + 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. 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 Network Management Specialist Grade 21 Work Experience - Required Network Work Experience - Preferred Education - Required Education - Preferred Bachelors License and Certifications - Required License and Certifications - Preferred Salary Range Salary Minimum: $45,655

    Salary Maximum:
    $68,485 This 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.

    Magellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live.

    Our strong culture of caring is the common thread in both our business strategy and our work environment. We value professional growth and development, total health and wellness, rewards and recognition as well as employee unity. Magellan is a place where you can thrive.

    Magellan is committed to providing equal employment opportunities to employees and applicants for employment without regard to race, color, creed, religion, sex, gender identity and expression, sexual orientation, marital status, age, national origin, ancestry, citizenship, physical or mental disability, disabled veteran or veteran of the Vietnam Era status, or any other factors protected by law.

    Magellan is committed to meeting applicable Federal labor and employment law posting requirements by providing necessary posters in a format which is easily accessible and conspicuous to all applicants.

    Copies of applicable posters are accessible by clicking here (.


    Warning:

    Employment Scam It has come to our attention that a false representative is contacting potential candidates and offering them work at home positions with Magellan Health.

    'Interviews' are conducted completely through email and the false job offer includes the promise of a check to be issued to the candidate for the purposes of setting up a home office.

    Please know that Magellan Health does not interview any candidate through email, nor do we issue checks to candidates to set up home offices.

    All of our available positions are posted on legitimate job boards and our recruitment team directly contacts candidates should there be a fit.

    If you suspect you are being contacted by a false representative of Magellan Health, please call To view full details and how to apply, please login or create a Job Seeker account
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