Network Management Specialist (Contract Specialist)

Network Management Specialist (Contract Specialist)

The Network Contract Specialist will be responsible for creating and maintaining behavioral health provider contracts across the New Mexico territory for Presbyterian Health Plan with Medicaid, Medicare, and Commercial lines of business. This role includes managing provider contracting activities in coordination with the Network team and processing all necessary contract-related updates. Key responsibilities include handling contract changes, Statements of Work, amendments, rate updates, Letters of Direction, and other required modifications. The specialist will also ensure all contract updates are compliant with internal policies and New Mexico-specific regulatory requirements. Strong collaboration with internal departments is essential to maintain network accuracy, provider data integrity, and overall operational efficiency. Detailed tracking and documentation of all contract activities and provider communications are critical components of this role.

Support and maintain behavioral health provider contracts for Medicaid, Medicare, and Commercial lines of business across the New Mexico territory.

Perform provider contracting functions in collaboration with the Network team.

Process contract-related updates including:

• Exhibits
• Contract changes
• Statements of Work
• Amendments
• Rate updates
• Letters of Direction (LODs)
• NCQA/CAQH

Ensure compliance with internal standards and state-specific requirements.

Collaborate with internal departments to support network accuracy, provider data integrity, and operational efficiency.

Maintain thorough documentation and tracking of all contract activity and communications.

This position is responsible for the support of all activities related to developing and maintaining the physician, practitioner, group, and/or facility, MPPS and organization services delivery system in small to mid-size market defined by membership, number of providers in delivery system, number of business operating units and lines of business. Interacts with all areas of organization to coordinate network management and network administration responsibilities.

Assess network needs, analyze network composition, and using organization databases, application of regulatory requirements, accreditation entities and other resources, recruit individual, group and/or organizational providers to meet network adequacy standards and assure quality network.

Conduct and coordinate contracting and amendment initiatives.

Provide issue resolution and complex trouble shooting for providers.

Conduct provider education and provider relation activities, providing necessary written materials.

Conduct administrative provider site visits and coordinate report development and completion according to contractual requirements or ad hoc requests.

Coordinate Public Policy Research Center (PPRC) activities to assure maintenance of current credentialing status, and evaluation and appropriate actions of quality of care issues and complaints against providers.

Conduct and manage ongoing audits of provider compliance with Magellan policies and procedures as well as contractual obligations for multiple customers. Develop work plans to address audit requirements.

Work with management to draft, clarify and recommend changes to policies which impact network 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.

Other Job Requirements:

Responsibilities:

Knowledge of National Committee for Quality Assurance (NCQA) requirements.

Ability to work independently and prioritize activities.

Intermediate knowledge of Microsoft Office Suite, specifically Excel.

Strong presentations skills using PowerPoint.

Minimum of 1 year experience in related position/field.

General Job Information:

Salary Minimum: $45,655

Salary Maximum: $68,485

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 Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.