![Magellan Health](https://assets.phenompeople.com/CareerConnectResources/pp/MAGAUS/images/job_logo_config-1575909707603.jpg)
Provider Liaison
4 weeks ago
- 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 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.
-
Provider Relations Liaison
4 weeks ago
Albuquerque, New Mexico, United States Magellan Health 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 delivery system, number of business operating units and lines of business. Interacts...
-
family/community support liaison
2 weeks ago
Albuquerque, New Mexico, United States Albuquerque Public Schools Full timeServes as a liaison between any combination of parents/families, district administrators, teachers, community, UNM/other educational program, human services, or other agencies dependent upon the assigned program. Provides assistance, facilitation, implementation, monitoring and/or coordination, which will vary dependent upon the assigned program. ESSENTIAL...
-
Albuquerque, New Mexico, United States Magellan Health Full timeThis position works collaboratively with child serving state agencies (e.g., Children, Youth, and Families Department) ensuring members receive care coordination and appropriate access to eligible and necessary services. Provides training and technical assistance to both internal and external stakeholders in order to enhance communication and coordination...
-
Community Liaison
2 weeks ago
Albuquerque, New Mexico, United States Ambercare Full timeCome work for one of the largest Home Health Care companies in the State of New Mexico. Ambercare is dedicated to your personal and professional growth through management training and employee appreciation. We also give back to the community by helping homebound persons remain in their homes by providing short-term financial assistance and locating community...
-
mental health tech i
2 weeks ago
Albuquerque, New Mexico, United States University of New Mexico - Hospitals Full timeSign-on Bonus available Receive 17% weekday nights, 26% weekend nights, or 15% weekend day shift differentialsDepartment: UPC Inpatient Adult ServicesFull TimeShift: Nights Provide child, adolescent, or adult patient care in a treatment or educational milieu; May operate in an in-patient/residential environment, or in outreach environment, such as in homes,...
-
Registered Nurse
1 week ago
Albuquerque, New Mexico, United States Veterans Health Administration Full timeResponsible and accountable for all elements of the nursing process when providing and/or supervising direct patient care. Assumes responsibility for the coordination of care focused on patient education, self-management, and customer satisfaction throughout the continuum of care. Follows procedures per established policies and guidelines. Influences care...
-
Associate/Sr. Associate Athletics Director – DEI
4 weeks ago
Albuquerque, New Mexico, United States University of New Mexico Full timeRequisition 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...
-
Advanced Medical Support Assistant
3 days ago
Albuquerque, New Mexico, United States Veterans Health Administration Full timeThe AMSA works collaboratively in an interdisciplinary coordinated care delivery model (i.e., PACT, Specialty Clinics, Compensation & Pension (C&P), Community Care) and performs clerical duties, customer service and other duties as assigned for the proper and timely treatment of patients.Major duties include but are not limited to:Act as a subject matter...
-
teacher: special education preschool dpc
2 weeks ago
Albuquerque, New Mexico, United States Albuquerque Public Schools Full timeServes as a liaison between area office special education staff and the young child with special needs by acting as an advocate for the developing young child with suspected special needs within the kindergarten environment through observation, identification, and appropriate intervention. ESSENTIAL FUNCTIONS: ESSENTIAL FUNCTIONS: Incumbent must achieve...
-
Albuquerque, New Mexico, United States Magellan Health Full timeResponsible 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...
-
Manager Locum Tenens
2 weeks ago
Albuquerque, New Mexico, United States UNM Medical Group, Inc. Full timeJob DescriptionJob DescriptionUNM Medical Group, Inc. is hiring for a Manager Locum Tenens to join our Locum Tenens team. This opportunity is a full-time day shift opening located in Albuquerque, New Mexico.Minimum $72,758 - Midpoint $92,747**Salary is determined based on years of total relevant experience.*Salary is based on 1.0 FTE (full time equivalent)...
-
Director, Case Management
2 weeks ago
Albuquerque, New Mexico, United States Lovelace Women's Hospital Full timeJob DescriptionOverviewLovelace Health System (LHS) has been dedicated to supporting the healthcare needs of the Albuquerque community since 1912. LHS consists of various hospitals, medical centers, and institutes providing quality services to the community. With a total of 613 licensed beds, LHS plays a vital role in the healthcare sector.POSITION...
-
HR Analyst
2 weeks ago
Albuquerque, New Mexico, United States ATA Services Inc Full timeATA Services is currently seeking to hire a highly experienced HR Analyst to work on a temporary assignment with Bernalillo County. Pay Rate: $25.00 per hour; weekly pay. Start Date: ASAP Schedule: Monday - Friday; 8 A.M - 5 P.M Location: Albuquerque, NM Position Summary & Duties Responsible: Under general supervision perform professional and technical...
-
HR Information Systems Specialist
2 weeks ago
Albuquerque, New Mexico, United States Atlanta Regional Commission Full timeThe Human Resources Information System Specialist will be responsible for implementing, supporting, and maintaining the organization's HRIS applications, systems, and modules.This role involves collaborating closely with the HR Director, HR team, and Leadership to develop streamlined processes that align with the organization's mission, vision, and values....
-
Financial Counselor
2 weeks ago
Albuquerque, New Mexico, United States Ardent Health Full timeOverview Join our team as a day shift , full-time , ER&OP Admitting Registration Financial Counselor in Albuquerque, NM . Fulf illing your purpose begins here: People First, Always . Here's how we take care of our people: Medical, vision, dental health insurance, health savings account / flexible spending, competitive pay, paid time off, 401k retirement...
-
Home Health Administrator
2 weeks ago
Albuquerque, New Mexico, United States Nuclear Care Partners Full timeOverview: Home Health Administrator We are actively seeking a talented and dynamic Administrator to lead our agency in the Albuquerque branch location. As a Home Health Administrator you play a critical role in leading daily operations, growing and mentoring an outstanding team of healthcare professionals and supporting the marketing of the agency's...
-
Licensed Clinician
2 weeks ago
Albuquerque, New Mexico, United States Community Options Full timeCommunity Options, Inc. is a national non-profit agency providing services to individuals with disabilities in 12 states. We are now hiring a Licensed Clinician in Albuquerque, New Mexico. The Licensed Clinician uses best practice within a community-based setting to apply social work methods to the diagnosis, prevention, and treatment of psycho-social...
-
Financial Counselor
2 weeks ago
Albuquerque, New Mexico, United States Ardent Health Full timeOverview Join our team as a day shift, full-time, ER&OP Admitting Registration Financial Counselor in Albuquerque, NM. Fulfilling your purpose begins here: People First, Always. Here's how we take care of our people: Medical, vision, dental health insurance, health savings account / flexible spending, competitive pay, paid time off, 401k retirement plan...
-
Security Specialist
2 weeks ago
Albuquerque, New Mexico, United States IntePros Federal Full timeThe Opportunity: IntePros Federal is seeking a Security Specialist in support of our federal government customer. The IT Systems Security Specialist supports the Office of the Information Officer to provide technical, analytical, and liaison support for implementing systems and network engineering functions and activities in line with the organization's IT...
-
Program Specialist
4 weeks ago
Albuquerque, New Mexico, United States tapwage Full timePosition 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...