CISC Senior Network Specialist
2 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.
- Partners with quality improvement in identifying and reporting trends, and identifying areas for improvement.
- Provides team leadership on network projects. Assures accurate and timely delivery of field network projects as assigned.
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 3 years experience in related position/field.General Job Information
Title
CISC Senior Network SpecialistGrade
23Work Experience - Required
NetworkWork Experience - Preferred
Education - Required
Education - Preferred
Bachelor'sLicense and Certifications - Required
License and Certifications - Preferred
Salary Range
Salary Minimum:
$53,125Salary Maximum:
$84,995This 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.
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