Provider Support Consultant
Company: Magellan Health
Posted on: August 17, 2019
We are seeking candidates who reside in either Brevard, Orange,
Osceola or Seminole County, Florida as they will work remotely and
travel 60-75% throughout those counties.
The Provider Support Consultant acts as the front-line liaison
between the health plan and provider offices to build and nurture
positive provider relationships and improve quality of care for
members. He/she provides education and provides support to high
volume clinics and providers. He/she is implements field and
provider practice-based quality initiatives and programs, completes
medical record reviews, and maintains relationships with providers
and clinics to improve upon existing services offered by providers.
He/she works both internally and externally to help ensure improved
population health of our members.Essential Functions
- Collaborates with contracted providers and delegated provider
groups to implement system changes, develop processes and support
other program development activities.
- Assesses current practice patterns, assets and challenges
utilizing NCQA, HEDIS, state and regulatory standards.
- Conducts provider office assessments and evaluates results of
the initial assessment to determine needs and opportunities for
- In provider office, schedules members for appointments to close
HEDIS gaps in care and for follow-up after hospitalization.
- Establishes a project plan with the practice that establishes
goals and objectives for improvement.
- Develops protocol for staff placed in provider offices
including policies and procedures.
- Ensures staff onsite in provider offices properly represent MCC
and follow the polices and procedures set forth by the health
- Provides ongoing practice support and sustains the partnership
by establishing regular meetings to track progress; provides
orientation, training, education meetings, presentations and focus
groups to improve mutual understanding and enhance working
partnerships with providers.
- Improves member experience to positively impact CAHPS
- Improves the understanding and sensitivity to the unique needs
of MCC's population and care givers.
- Schedules members for appointments as sites allow.
- Evaluates program for barriers and opportunities and make
changes as appropriate.
- Provides on-site support in provider offices for the completion
of clinical interventions.
- Coordinates community engagement activities to help improve
- Multi-departmental collaboration for member and provider
- Performs other duties and projects as assigned. General Job
Information Title Provider Support ConsultantGrade23 Job Family
Clinical Services Group Country United States of America FLSA
Status United States of America (Exempt) Recruiting Start Date
6/6/2019 Date Requisition Created 6/4/2019 Work Experience Managed
Healthcare, Quality Education Bachelors: Healthcare (Required),
Bachelors: Nursing (Required), Bachelors: Social Work (Required),
Masters 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, QMHP - Qualified Mental
Health Professional - 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
- Registered Nurse or other appropriate clinical licensure
- Bachelor's degree in healthcare or related discipline
- Three plus years of experience in quality management
- Demonstrated understanding of healthcare industry standards,
HEDIS and NCQA
- Proficient in Microsoft Office tools
- Strong analytical skills and strategic thinking
- Strong communication skills, both verbally and written
- Ability to interact effectively with business owners, senior
management, and peers across the organization
- Ability to travel regionally 60-75% in fieldPreferred
- Master's degree in related discipline or equivalent work
- Demonstrated experience in leading significant cross-functional
- Excellent knowledge of HEDIS, NCQA, Medicare Stars and
- Conceptual and in-depth knowledge of the healthcare
- Ability to manage relationships with an emphasis on internal
and external mid-level relationships
- Ability to work across all levels of the organization,
including working with executive audiences, vendors and the
government as a customer
- Demonstrated ability to select and implement strategies that
are most likely to be successful
- Minimum three years experience in managed care ---Magellan
Health Services is proud to be an Equal Opportunity Employer and a
Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must
understand, comply and attest to the security responsibilities and
security controls unique to their position.
Keywords: Magellan Health, Orlando , Provider Support Consultant, Professions , Orlando, Florida
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