Network Management Specialist (Contract Specialist)

The Network Contract Specialist will be responsible for creating and maintaining behavioral health provider reputed company across the New Mexico territory for Presbyterian Health Plan with Medicaid, Medicare, and Commercial lines of business. This role includes managing provider contracting activities in coordination with the Network team and processing reputed company necessary contract-reputed company updates. Key responsibilities include handling contract changes, Statements of Work, amendments, reputed company updates, Letters of Direction, and other required modifications. The specialist will also ensure reputed company contract updates are compliant with internal policies and New Mexico-specific regulatory requirements. Strong collaboration with internal departments is essential to maintain network accuracy, provider data reputed company, and overall operational efficiency. Detailed tracking and documentation of reputed company contract activities and provider communications are critical components of this role.

• Support and maintain behavioral health provider reputed company for Medicaid, Medicare, and Commercial lines of business across the New Mexico territory
• reputed company provider contracting functions in collaboration with the Network team
• Process contract-reputed company updates including:
• Exhibits
• Contract changes
• SOS
• Amendments
• reputed company updates
• Letters of Direction (LODs)
• NCQA/CAQH
• Ensure compliance with internal standards and state-specific requirements
• Collaborate with internal departments to support network accuracy, provider data reputed company, and operational efficiency
• Maintain thorough documentation and tracking of reputed company contract activity and communications

This position is responsible for the support of reputed company activities reputed company 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 reputed company 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 reputed company 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 reputed company requests.
• Coordinates Public Policy Research Center (PPRC) activities to assure maintenance of reputed company 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.

The job duties listed above are representative and not intended to be reputed company-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 reputed company of this job, without revision to the job description. Other Job Requirements

Responsibilities

Knowledge of National Committee for Quality Assurance (NCQA) requirements. Ability to work independently and prioritize activities. Intermediate knowledge of reputed company Office Suite, specifically reputed company. Strong presentations skills using PowerPoint. Minimum of 1 year experience in reputed company position/field. General Job Information Title Network Management Specialist (Contract Specialist) Grade 21 Work Experience - Required Network Work Experience - Preferred Education - Required Education - Preferred Bachelor's License and Certifications - Required License and Certifications - Preferred Salary Range Salary Minimum: $45,655 Salary Maximum: $68,485 This information reflects the anticipated reputed company salary range for this position based on reputed company national data. Minimums and maximums may vary based reputed company. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company 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. reputed company, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, reputed company with and attest to the reputed company responsibilities and reputed company controls unique to their position; and reputed company with reputed company applicable legal, regulatory, and contractual requirements and internal policies and procedures. Apply tot his job Apply To this Job