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Provider Support Specialist

Posted on May 18, 2019 by Magellan Health

Saint Petersburg, FL 33706
Health Care
Immediate Start
Annual Salary
Full-Time
Implements programs to build and nurture positive provider relationships and improve the quality of care for enrollees. Provides education and support including orientation to the plan, facilitation of best practices to improve provider processes, and quality and practice guidelines. Collaborates with internal departments to assist with strategies related to the development and management of the provider network. Responds to provider issues, problem-solves with internal clinical, operations and other stakeholders to achieve positive outcomes and improve workflows. Works with the Quality Department to implement field and provider practice based quality initiatives and programs, medical record reviews, and interfaces with HEDIS vendor in the field. Assesses practice readiness for working with SPMI (Serious and Persistent Mental Illness) members and supports provider practices using a broad set of tools, resources and reports.
  • Provides orientation, training, education meetings, presentations, and focus groups to improve mutual understanding and enhance working partnerships with providers.
  • Works with provider groups to improve quality, outcomes and efficiency and to adopt best practices.
  • Assists with brokering the relationship between BH and PH providers.
  • Works with our providers to transform data into actionable information at the practice and member level e.g. gaps in care, quality and utilization, etc.
  • Offers basic trainings and webinars for providers and office staff re: SPMI population co-occurring disorders, stigma, poverty, disparities, substance abuse, reduce discrimination.
  • Performs medical record reviews as needed.
  • Responds to provider inquiries via phone, e-mail, secure web messaging.
  • Supports processes that address provider complaints, claims, contracting, credentialing and other problems requiring follow-up and resolution.
  • Facilitates immediate resolution of red-flag provider issues that are client, community, legal, or contractual threats with internal personnel as needed.
  • Assists in development and management of weekly, monthly, quarterly reports.
  • Other duties as assigned.

General Job Information

Title

Provider Support Specialist

Grade

23

Job Family

Clinical Services Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

12/6/2018

Date Requisition Created

11/29/2018

Minimum Qualifications

Education

Bachelors: Nursing (Required), Masters: Behavioral Health (Required)

License and Certifications - Required

LAC - Licensed Associate Counselor - Care Mgmt, LCSW - Licensed Clinical Social Worker - Care Mgmt, LMFT - Licensed Marital and Family Therapist - Care Mgmt, PSY - Psychologist - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt

License and Certifications - Preferred

CPHQ - Certified Professional In Healthcare Quality - Care Mgmt

Other Job Requirements

Responsibilities

  • 5+ in a Healthcare environment.
  • Ability to travel regionally 60-75% in field.
  • Masters level licensed Registered Nurse (RN).
  • Strong knowledge of Medicaid.
  • Experience with practice facilitation or provider relations.

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

Reference: 708095248