Provider Engagement Specialist- Tribal Outreach Liaison

• Tribal Outreach Liaison, ideally hired from within an Idaho Tribal Nation or extensive experience working directly with tribal governments.

• Tribal healthcare experience preferred.

• The Liaison will be the primarily Magellan point of content for Idaho Tribes and be responsible for regular outreach, engagement, and problem solving with tribal communities, and shall also develop a tribal communities outreach and engagement plan.

Responsibilities include building and maintaining an adequate provider network to meet the needs of the member population. Monitoring and reporting on network adequacy (geo access), recruitment of new providers (sending and negotiating provider agreements), establishing and maintaining strong relationships with providers, provider education and training, and provider issue resolution. Duties also include provider site visits, in-person & virtual provider meetings, and representing network on client meetings.

• Recruit new providers and document recruitment efforts.

• Negotiate reimbursement rates with providers in accordance with set rate parameters.

• Responsible for timely turnaround of agreements in accordance with the company and client standards.

• Act as liaison between Clinical, Quality, and Network and the provider community, sharing provider feedback to internal groups, identifying best practices and driving collaboration.

• Represent Magellan at client meetings, community events, conferences, and advocacy groups (in-person and virtually).

• Communicate extensively (by telephone, in-person, and email) with Providers for support, issue resolution, and collaboration.

• Provide orientation, education, training, and support to Magellan contracted providers on Magellan systems, policies, requirements, online tools, and resources.

• Report on network initiatives, network adequacy, network trends, and recruitment to Network Management and internal Magellan teams.

• Provide summary and problem specific feedback information, analysis and action recommendations to management and relevant functional units regarding provider problems, issues, and general concerns impacting working relationships.

• Collaborate with internal Magellan teams (Clinical, Quality, Network) to implement and drive regional and corporate initiatives.

• Other duties as assigned by management.

Other Job Requirements

Responsibilities

2+ years' experience in a Customer Care/Healthcare environment with experience in eligibility, authorization and claims problem resolution.

2+ years' experience in network development with demonstrated focus on contracting and rate negotiation.

Excellent organizational and rate negotiation skills required.

Ability to handle multiple tasks simultaneously.

Must be customer service oriented.

Must be a team player.

Must be able to maintain provider confidentiality at all times.

Must demonstrate effective problem solving skills.

Must have excellent verbal and writing skills.

Must have working knowledge of Microsoft Office suite and data entry experience .

General Job Information

Title

Provider Engagement Specialist- Tribal Outreach Liaison

Grade

23

Work Experience

• Required

Customer Service, Healthcare, Network

Work Experience

• Preferred

Education

• Required

Education

• Preferred

Bachelor's

License and Certifications

• Required

License and Certifications

• Preferred

Salary Range

Salary Minimum:

$53,125

Salary Maximum:

$84,995

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.