Director, Network Development - Clinical Background Required

Magellan Health • Boise, ID

12d

About The Position

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

Requirements

• 8+ years managed healthcare experience
• Significant experience in progressive network management and development
• Knowledge of NCQA requirements

Responsibilities

• Development of the provider network, assuring network adequacy and appointment access
• Development of network resources in response to unmet needs
• Adequacy of the provider network to provide member choice of providers
• Contracting with qualified service providers in compliance with federal and state laws
• 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
• Annual network development plan as well as key business development activities as assigned
• Lead 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
• Conduct 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
• Operate 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

Benefits

• Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 5,001-10,000 employees