Job: Provider Network Coordinator (PA)

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Job Title Provider Network Coordinator (PA)
Category Customer Service, Healthcare
Job Information

Essential Functions:

  • Under direction of Field Network Director/Manager, 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 adhoc requests.
  • Coordinates 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.

Minimum Requirements:

  • Education: BA/BS.
    Experience: Minimum of 1 year experience in behavioral healthcare related field.
    An equivalent combination of experience and education is acceptable.
  • Computer Skills: Intermediate knowledge of Microsoft Office Software necessary including Excel, Project, Word, Access, and Power Point.
    Ability to travel by auto and air required, knowledge of NCQA requirements. Ability to work independently and prioritize activities.
    Minimum of 1 year in giving presentations

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