This position is responsible for the development of the provider network, assuring network adequacy and appointment access, development of network resources in response to unmet needs, and adequacy of the provider network to provide member choice of providers, and contracting with qualified service providers in compliance with federal and state laws. This role will lead Magellan's strategy and planning in the successful development of the provider network including network development, contracting, credentialing and provider communications for existing or emerging markets, as assigned. Role is responsible for the annual network development plan as well as key business development activities as assigned.
- Leads network planning and strategy efforts to support the successful implementation or transformation of the various delivery systems, including assisting in all network related activities during new contract implementations
- Conducts market research for emerging markets and develops Capture Strategy specific to the provider network - SWOT Analysis of each Tier 1 Priority State specific to the current provider delivery system as applicable.
- Operates as a Network SME for all active proposals, work with the existing national network team to drive solutions, actively storyboard solutions to identified problems, and assist in preparing content post RFP release.
- Travel to identified opportunity, facilitating meetings in the market with providers, provider associations etc. and develop comprehensive summaries of all provider engagement as needed
- Contribute to comprehensive work plans geared towards understanding the Network, building out a comprehensive list of all provider types including training, qualifications, and cost requirements.
- Plans, develops and ensures implementation and positive outcomes of the Annual Network Development Plan including network adequacy and appointment access, development of network resources in response to unmet needs, contracting with qualified service providers and compliance with Federal and State laws.
- Leads and provides direction to the Magellan Network team including all development responsibilities.
- Leads provider recruitment activities and ensures compliance with contracting, credentialing and privileging policies and procedures.
- Ensures the Network Transition Plan is successful meeting all established timeframes.
- Other network related activities as assigned.
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.
Other Job Requirements
Responsibilities
8+ years managed healthcare experience.
Significant experience in progressive network management and development. Knowledge of NCQA requirements.
Work Experience - Required
Network
Education - Required
A Combination of Education and Work Experience May Be Considered., Bachelor's
Salary Range
Salary Minimum:
$105,230
Salary Maximum:
$178,890
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 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.
10-15 years96
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Job Description
Download ResumeThis position is responsible for the development of the provider network, assuring network adequacy and appointment access, development of network resources in response to unmet needs, and adequacy of the provider network to provide member choice of providers, and contracting with qualified service providers in compliance with federal and state laws. This role will lead Magellan's strategy and planning in the successful development of the provider network including network development, contracting, credentialing and provider communications for existing or emerging markets, as assigned. Role is responsible for the annual network development plan as well as key business development activities as assigned.
- Leads network planning and strategy efforts to support the successful implementation or transformation of the various delivery systems, including assisting in all network related activities during new contract implementations
- Conducts market research for emerging markets and develops Capture Strategy specific to the provider network - SWOT Analysis of each Tier 1 Priority State specific to the current provider delivery system as applicable.
- Operates as a Network SME for all active proposals, work with the existing national network team to drive solutions, actively storyboard solutions to identified problems, and assist in preparing content post RFP release.
- Travel to identified opportunity, facilitating meetings in the market with providers, provider associations etc. and develop comprehensive summaries of all provider engagement as needed
- Contribute to comprehensive work plans geared towards understanding the Network, building out a comprehensive list of all provider types including training, qualifications, and cost requirements.
- Plans, develops and ensures implementation and positive outcomes of the Annual Network Development Plan including network adequacy and appointment access, development of network resources in response to unmet needs, contracting with qualified service providers and compliance with Federal and State laws.
- Leads and provides direction to the Magellan Network team including all development responsibilities.
- Leads provider recruitment activities and ensures compliance with contracting, credentialing and privileging policies and procedures.
- Ensures the Network Transition Plan is successful meeting all established timeframes.
- Other network related activities as assigned.
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.
Other Job Requirements
Responsibilities
8+ years managed healthcare experience.
Significant experience in progressive network management and development. Knowledge of NCQA requirements.
Work Experience - Required
Network
Education - Required
A Combination of Education and Work Experience May Be Considered., Bachelor's
Salary Range
Salary Minimum:
$105,230
Salary Maximum:
$178,890
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 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.