Network Management Specialist (Contract Specialist)

Network 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.

Responsibilities include:

• 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, and 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

Additional duties include:

• Assess network needs, analyze network composition, and 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 troubleshooting 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 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.

Other job requirements:

• 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 presentation skills using PowerPoint.
• Minimum of 1 year experience in related position/field.

General job information:

• Title: Network Management Specialist (Contract Specialist)
• Grade: 21
• Work Experience - Required: Network
• Work Experience - Preferred:
• Education - Required:
• Education - Preferred: Bachelor's
• License and Certifications - Required:
• License and Certifications - Preferred:

Salary Range:

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 offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing. Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.