Network Management Specialist (Contract Specialist) Albuquerque, NM
Network Management Specialist (Contract Specialist) Albuquerque, NM
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1 Vacancy
Job Description
ATTENTION MILITARY AFFILIATED JOB SEEKERS- Our organization works with partner companies to source qualified talent for their open roles. The following position is available toVeterans Transitioning Military National Guard and Reserve Members Military Spouses Wounded Warriors and their Caregivers. If you have the required skill set education requirements and experience please click the submit button and follow the next steps. Unless specifically stated otherwise this role is On-Site at the location detailed in the job post.
The Network Contract Specialist will be responsible for creating and maintaining behavioral health provider contracts 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 all necessary contract-related updates. Key responsibilities include handling contract changes Statements of Work amendments rate updates Letters of Direction and other required modifications. The specialist will also ensure all 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 integrity and overall operational efficiency. Detailed tracking and documentation of all contract activities and provider communications are critical components of this role.
Support and maintain behavioral health provider contracts for Medicaid Medicare and Commercial lines of business across the New Mexico territory
Perform provider contracting functions in collaboration with the Network team
Process contract-related updates including:
Exhibits
Contract changes
SOS
Amendments
Rate 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 integrity and operational efficiency
Maintain thorough documentation and tracking of all contract activity and communications
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.
The job duties listed above are representative and not intended to be all-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 intent of this job without revision to the job description.
Additional Qualifications/Responsibilities
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
Network Management Specialist (Contract Specialist)
Grade
21
Work Experience - Required
Network
Work Experience - Preferred
Education - Required
Education - Preferred
Bachelors
License and Certifications - Required
License and Certifications - Preferred
Salary Range
Salary Minimum:
$45655
Salary Maximum:
$68485
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 individuals 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.
Required Experience:
Unclear Seniority
Employment Type
Contract
