Network Management Specialist
United States United States, United States Minor Outlying Isl 99999 US
Job Description
Location: Work from Home
Schedule: Mon – Fri, 8:00AM – 5:00PM EST; flexible hours may be required to support other timezones
Note: This is a W2 contract role, and is NOT open to C2C or 3rd party candidates
The Network Management Specialist will assess network needs, analyze network composition and organizational databases, application of regulatory requirements, accreditation entities, and other resources to conduct and coordinate contracting and amendment initiatives, including recruit individuals, groups, and/or organizational providers to meet network adequacy standards and assure the quality of the network.
Position Qualifications:
- Provide issue resolution and complex troubleshooting for providers
- Conduct provider education and provider relation activities, providing necessary written materials
- Conduct administrative provider site visits and coordinate report development and completion according to contractual requirements or ad hoc requests
- Coordinate Public Policy Research Center (PPRC) activities to assure maintenance of current credentialing statuses, evaluation, and appropriate actions of quality-of-care issues and complaints against providers
- Conduct and manage ongoing audits of provider compliance with Magellan policies and procedures, as well as contractual obligations for multiple customers
- Develop work plans to address audit requirements
- Works with management to draft, clarify, and recommend changes to policies which impact network management
- A minimum of 1 year of experience in a network development, provider recruitment, or provider contracting role
- A minimum of 1 year of experience with computer networking systems
- Strong customer service/support experience, with strong verbal communication and sales skills
- Ability to work independently and prioritize activities
- Intermediate knowledge of Microsoft Office Suite, including data analysis skills using Excel and presentation skills using PowerPoint
- Knowledge of National Committee for Quality Assurance (NCQA) requirements preferred
- Military experience/background preferred
- Bilingual English/Spanish speaking skills preferred
- A minimum of a Bachelors Degree in Computer Science, Information Technology, or other related field preferred