Provider Engagement Specialist- Tribal Outreach Liaison

Magellan Health•Boise, ID

65d

About The Position

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. 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.

Requirements

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

Responsibilities

Regular outreach, engagement, and problem solving with tribal communities
Develop a tribal communities outreach and engagement plan
Build and maintain an adequate provider network
Monitor and report on network adequacy
Recruit new providers
Negotiate provider agreements
Establish and maintain strong relationships with providers
Provide provider education and training
Resolve provider issues
Conduct provider site visits
Attend in-person & virtual provider meetings
Represent network on client meetings
Recruit new providers and document recruitment efforts
Negotiate reimbursement rates with providers
Act as liaison between Clinical, Quality, and Network and the provider community
Represent Magellan at client meetings, community events, conferences, and advocacy groups
Communicate extensively with Providers for support, issue resolution, and collaboration
Provide orientation, education, training, and support to Magellan contracted providers
Report on network initiatives, network adequacy, network trends, and recruitment
Provide summary and problem specific feedback information, analysis and action recommendations to management
Collaborate with internal Magellan teams to implement and drive regional and corporate initiatives
Other duties as assigned by management