Provider Relations Liaison

2 weeks ago


Albuquerque, New Mexico, United States Magellan Health Full time
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

Provider Relations Liaison

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 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.


  • Provider Liaison

    2 weeks ago


    Albuquerque, New Mexico, United States Magellan Health Full time

    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...


  • Albuquerque, New Mexico, United States Mitchell Martin Inc Full time

    Our client, a member owned health insurance company, is seeking a Provider Services RepresentativeLocation: Albuquerque, NMPosition Type: ContractJob Requirements:Maintain accuracy of provider information in core internal and member facing systems. Requires frequent contact with our provider partners to confirm the accuracy of information provided with 95%...

  • Program Specialist

    6 days ago


    Albuquerque, New Mexico, United States tapwage Full time

    Position Title: Program SpecialistEmployee Classification: Program SpecialistCollege/Division: Cooperative Extension ServiceDepartment:EXTENSN HOME EC PGM UNITInternal or External Search: External - Open to all applicantsLocation: Remote LocationsOffsite Location (if applicable): Any county within the state of NMTarget Hourly/Salary Rate: 38,426Appointment...


  • Albuquerque, New Mexico, United States Magellan Health Full time

    Responsible for the development, strategy, and implementation of community outreach programs in conjunction with the Clinical and Administrative departments. Leads the development of strategic plans for engagement, within assigned territories, regions or communities, that nurture and retain positive relationships between the health plan, members and...


  • Albuquerque, New Mexico, United States University of New Mexico Full time

    Requisition ID req28939Working Title Associate/Sr. Associate Athletics Director – DEI & Student-Athlete DevelopmentPosition Grade 15Position SummaryThe Associate or Senior Associate Athletics Director - DEI and Student-Athlete Development will be responsible for the development and oversight of the DEI Division and the Student-Athlete Development Division...

  • Recruiter

    2 months ago


    Albuquerque, New Mexico, United States University of New Mexico Full time

    Requisition ID req28856Working Title RecruiterPosition Grade 11Position SummaryThe College of Pharmacy is seeking an energetic, outgoing recruitment professional to serve as the recruiter for admissions for various Pharmacy education programs. The recruiter provides a vital touchpoint for initial interactions with potential students. This position requires...


  • Albuquerque, New Mexico, United States Department Of Homeland Security Full time

    Summary This position is located within the Department of Homeland Security (DHS), Immigration and Customs Enforcement (ICE), Enforcement and Removal Operations (ERO), ICE Health Service Corps (IHSC), Office of Deputy Assistant Director of Clinical Services, Office of Medical Case Management. The incumbent will report directly to the Regional Field Medical...


  • Albuquerque, New Mexico, United States University of New Mexico Full time

    Requisition ID req28804Working Title Communication & Outreach SpecPosition Grade 12Position SummaryThe UNM Health Sciences Office for Diversity, Equity & Inclusion (OfDEI) is seeking a knowledgeable, detail-oriented individual to support the growing needs within the office. This individual will primarily engage with faculty and staff of the office providing...

  • Loan Officer

    1 week ago


    Albuquerque, New Mexico, United States tapwage Full time

    Job DetailsDescriptionGuild Mortgage Company, closing loans and opening doors since 1960. As a mortgage banking firm we are dedicated to serving the home owner/buyer. Our goal is to provide affordable home financing for our customers, utilizing the best terms available while providing a level of professionalism and service unsurpassed in the lending...

  • Senior Data Analyst

    3 days ago


    Albuquerque, New Mexico, United States Presbyterian Healthcare Services Full time

    Overview:Now hiring a Senior Data AnalystSummary:Provide reporting/analytics and statistical expertise for development of accurate solutions based on business needs. Analyze and synthesize related and seemingly unrelated data into an audience appropriate story to support the business initiatives, accreditation, and regulatory compliance. Act as a data...


  • Albuquerque, New Mexico, United States Rocket Lab Full time

    ABOUT ROCKET LABRocket Lab is a global leader in launch and space systems. The rockets and satellites we build and launch enable some of the most ambitious and vital space missions globally, supporting scientific exploration, Earth observation and missions to combat climate change, national security, and exciting new technology demonstrations. Our Electron...

  • Field Engineer

    6 days ago


    Albuquerque, New Mexico, United States AtkinsRéalis Full time

    Job DescriptionWhy join us? We are hiring AtkinsRéalis is seeking a Field Engineer to join office our team in New Mexico About Us AtkinsRéalis is one of the world's most respected design, engineering and project management consultancies. AtkinsRéalis has been providing infrastructure planning, engineering, construction, environmental consulting, urban...


  • Albuquerque, New Mexico, United States Presbyterian Healthcare Services Full time

    Overview:Now hiring IT Operations Systems AnalystThe IT Operations Analyst will be responsible for the operational triage & support of back-end transactional systems and data integrations.This role will be accountable for break/fix operational support as well as new development & enhancements with limited supervision. The analyst will handle all phases of...


  • Albuquerque, New Mexico, United States Compass Connections Full time

    It's a great feeling to work for a company that does so much good for others around the worldApplicant must be able to communicate effectively in writing and verbally in English and Spanish.Academic Req:Bachelor's or undergraduate degree from an accredited program/university, preferably in one of the following areas: social work, psychology, criminal...


  • Albuquerque, New Mexico, United States University of New Mexico Full time

    Student Intermediate Level Requisition IDreq27565Working TitleCommunity Social Media Outreach AssistantPay$14.50 HourlyCampusMain – Albuquerque, NMDepartmentCCRCE Admin (365B)Employment TypeStudent EmploymentStudent TypeStudent EmploymentStatusNon-ExemptBackground Check RequiredNoFor Best Consideration Date11/30/2023Position SummaryInterested in managing...


  • Albuquerque, New Mexico, United States Isleta Resort & Casino Full time

    AGE REQUIREMENT: 21 years or olderPosition Summary:Responsible for assuring the network and telecom needs of Isleta Resort and Casino are met through design, implementation and maintenance of the LAN/WAN. Primarily responsible for maintaining secure and efficient operations of all company networks, network-based equipment and systems. Supports all network...

  • Response Task Force

    2 weeks ago


    Albuquerque, New Mexico, United States ASRC Federal Holding Company Full time

    ASRC Federal NetCentric Technology, LLC is seeking a Response Task Force (RTF) Program Manager to support ongoing activities on our KEOS contract at Kirtland AFB in Albuquerque, New Mexico.Job Summary : The primary purpose of this position is to function as the Response Task Force (RTF) Program Manager, responsible for managing RTF (Type 1) operations...


  • Albuquerque, New Mexico, United States MedPro Healthcare Allied Staffing Full time

    MedPro Healthcare Allied Staffing is seeking a travel Physical Therapist for a travel job in Albuquerque, New Mexico. Job Description & RequirementsSpecialty: Physical TherapistDiscipline: TherapyStart Date: 06/24/2024Duration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelMedPro Healthcare Staffing, a Joint Commission-certified...

  • Travel Nurse RN

    7 days ago


    Albuquerque, New Mexico, United States MedPro Healthcare Staffing Full time

    MedPro Healthcare Staffing is seeking a travel nurse RN PCU - Progressive Care Unit for a travel nursing job in Albuquerque, New Mexico. Job Description & RequirementsSpecialty: PCU - Progressive Care UnitDiscipline: RNStart Date: 06/24/2024Duration: 13 weeks36 hours per weekShift: 12 hours, nightsEmployment Type: TravelMedPro Healthcare Staffing, a Joint...


  • Albuquerque, New Mexico, United States Magellan Health Full time

    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...