Provider Support Consultant

Magellan Health - Virginia Beach, VA3.6

We are seeking a Provider Support Consultant who will work remotely and resides in the Tidewater region which consists of the area from Gloucester, Williamsburg, Suffolk to Virginia Beach, Virginia. The Provider Support Consultant will need to come into the Richmond, VA office as needed and this position also requires about 75% travel throughout the state of Virginia.

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 collaboration.
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 Magellan Complete Care (MCC) and follow the polices and procedures set forth by the health plan.
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 scores.
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 member compliance.
Multi-departmental collaboration for member and provider outreach activities.
Performs other duties and projects as assigned.
General Job Information


Provider Support Consultant

Job Family

Clinical Services Group

United States of America
FLSA Status

United States of America (Exempt)
Recruiting Start Date

Date Requisition Created

Work Experience

Managed Healthcare, Quality

Bachelors: Healthcare (Required), Bachelors: Nursing (Required), Bachelors: Social Work, 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


Required Qualifications

Registered Nurse or 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
Experience working with providers
Ability to interact effectively with business owners, senior management, and peers across the organization
Preferred Qualifications

Master’s degree in related discipline or equivalent work experience
Demonstrated experience in leading significant cross-functional work
Excellent knowledge of HEDIS, NCQA, Medicare Stars and Medicaid
Ability to create innovative campaigns for various HEDIS and NCQA measures
Conceptual and in-depth knowledge of the healthcare industry
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.