Magellan Health

The Care Coordinator is responsible for coordinating care for individual clients, focusing on assessment, care planning, and monitoring to ensure quality outcomes. They also advocate for members' care needs and facilitate collaboration among various stakeholders. | Candidates should have 3-5 years of experience in social work, nursing, or a healthcare-related field, with a strong background in utilization management and community health. A valid driver's license is required, and certifications such as CCM or LCSW are preferred. | Coordinates care of individual clients with application to identified populations using assessment, care planning, implementations, coordination, monitoring and evaluation for cost effective and quality outcomes. Duties are typically performed during face-to-face home visits. Promotes the appropriate use of clinical and financial resources in order to improve the quality of care and member satisfaction. Assists with orientation and mentoring of new team members as appropriate. Provides care coordination to members with behavioral health conditions identified and assessed as requiring intensive interventions and oversight including multiple, clinical, social and community resources. Conducts in depth health risk assessment and/or comprehensive needs assessment which includes, but is not limited to psycho-social, physical, medical, behavioral, environmental, and financial parameters. Communicates and develops the care plan and serves as point of contact to ensure services are rendered appropriately, (i.e. during transition to home care, back up plans, community based services). Implements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes. Develops, documents and implements plan which provides appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs. Acts as an advocate for member`s care needs by identifying and addressing gaps in care. Performs ongoing monitoring of the plan of care to evaluate effectiveness. Measures the effectiveness of interventions as identified in the members care plan. Assesses and reviews plan of care regularly to identify gaps in care, trends to improve health and quality of life outcomes. Collects clinical path variance data that indicates potential areas for improvement of case and services provided. Works with members and the interdisciplinary care plan team to adjust plan of care, when necessary. Educates providers, supporting staff, members and families regarding care coordination role and health strategies with a focus on member-focused approach to care. Facilitates a team approach to the coordination and cost effective delivery to quality care and services. Facilitates a team approach, including the Interdisciplinary Care Plan team, to ensure appropriate interventions, cost effective delivery of quality care and services across the continuum. Collaborates with the interdisciplinary care plan team which may include member, caregivers, member`s legal representative, physician, care providers, and ancillary support services to address care issues, specific member needs and disease processes whether, medical, behavioral, social, community based or long term care services. Utilizes licensed care coordination staff as appropriate for complex cases. Provides assistance to members with questions and concerns regarding care, providers or delivery system. Maintains professional relationship with external stakeholders, such as inpatient, outpatient and community resources. Generates reports in accordance with care coordination goal. 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 3-5 years experience in Social Work, Nursing, or Healthcare-related field, or relevant experience in lieu of degree., Experience in utilization management, quality assurance, home or facility care, community health, long term care or occupational health required. Experience in analyzing trends based on decision support systems. Business management skills to include, but not limited to, cost/benefit analysis, negotiation, and cost containment. Knowledge of referral coordination to community and private/public resources. Requires detailed knowledge of cost-effective coordination of care in terms of what and how work is to be done as well as why it is done, this level include interpretation of data. Ability to make decisions that require significant analysis and investigation with solutions requiring significant original thinking. Ability to determine appropriate courses of action in more complex situations that may not be addressed by existing policies or protocols. Decisions include such matters as changing in staffing levels, order in which work is done, and application of established procedures. Ability to maintain complete and accurate enrollee records. Effective verbal and written communication skills. Ability to work well with clinicians, hospital officials and service agency contacts. General Job Information Title Care Coordinator- CISC Grade 22 Work Experience - Required Clinical, Quality Work Experience - Preferred Education - Required GED, High School Education - Preferred Associate, Bachelor's License and Certifications - Required DL - Driver License, Valid In State - OtherOther License and Certifications - Preferred CCM - Certified Case Manager - Care MgmtCare Mgmt, LCSW - Licensed Clinical Social Worker - Care MgmtCare Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care MgmtCare Mgmt Salary Range Salary Minimum: $50,225 Salary Maximum: $75,335 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. Magellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live. Our strong culture of caring is the common thread in both our business strategy and our work environment. We value professional growth and development, total health and wellness, rewards and recognition as well as employee unity. Magellan is a place where you can thrive. Magellan is committed to providing equal employment opportunities to employees and applicants for employment without regard to race, color, creed, religion, sex, gender identity and expression, sexual orientation, marital status, age, national origin, ancestry, citizenship, physical or mental disability, disabled veteran or veteran of the Vietnam Era status, or any other factors protected by law. Magellan is committed to meeting applicable Federal labor and employment law posting requirements by providing necessary posters in a format which is easily accessible and conspicuous to all applicants. Copies of applicable posters are accessible by clicking here. Warning: Employment Scam It has come to our attention that a false representative is contacting potential candidates and offering them work at home positions with Magellan Health. “Interviews” are conducted completely through email and the false job offer includes the promise of a check to be issued to the candidate for the purposes of setting up a home office. Please know that Magellan Health does not interview any candidate through email, nor do we issue checks to candidates to set up home offices. All of our available positions are posted on legitimate job boards and our recruitment team directly contacts candidates should there be a fit. If you suspect you are being contacted by a false representative of Magellan Health, please call 410-953-2911

Providing personal financial counseling, conducting workshops, and developing financial materials for military service members and their families. | Requires a bachelor's degree, 3+ years of financial counseling experience, and specific certifications such as AFC, CFP, or ChFC. | This position will provide coverage in short-term, surge and on demand situations resulting from the Military needs such as a post-deployment event or to cover an existing assignment for counselors who are absent. Primary responsibilities include the full breadth of personal financial counseling services to military service members and their families at military installations. Services include education and counseling addressing financial services that may include, but are not limited to, one-on-one counseling, consultation with a commander or with another provider or staff, conducting briefings and presentations, or providing referral resources to a participant outside the context of a counseling session. Works closely with the installation and military branch Points of Contact (POC) to assure that the program is provided within scope and meets the needs of the installation. Provides personal financial counseling and management services directly to service members and their families. Assists service members in establishing a spending plan for extended absences. Develops and makes available informational financial materials to service members and families. Coordinates, publicizes and provides a wide variety of Personal Financial Management classes/workshops, e.g., topics across the military lifecycle, including, but not limited to, arrival at first duty station, pre- and post-deployment, and personal and career events outlined in DoDI 1322.34. Responds to requests for age-appropriate classes or seminars. Possess the skills to effectively utilize virtual counseling or other electronic modes of communication, such as web based, secure online chat, or video-based communications and secure video teleconference sponsored by the customer. Virtual PFC support may only be authorized by OSD FINRED Program office. Manages duty to warn situations according to Department of Defense (DoD) protocol. Communicates with leadership and participates in regular individual and group supervision, sharing information regarding trends and issues on the installations to which the counselor is assigned. Participates in regular in-services/training, quality improvement committees or other contract activities as assigned/appropriate. All other duties as assigned. 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 Bachelor's degree required. May consider applicants with an associate degree plus 4 years' experience in lieu of bachelor's degree. May consider applicants with a high school diploma plus 6 years' experience in lieu of a bachelor's degree. 3+ years of financial counseling experience. Must be a U.S. citizen and speak fluent English. If required by the contract, must be bilingual in English and Spanish. Be able to obtain a favorably adjudicated Tier 2 investigation. Must be able to pass the Congressionally Mandated Disclosures for Organizational Conflicts of Interest (OCI) process. Must have one of the following certifications: Accredited Financial Counselor (AFC), Certified Financial Planner (CFP), or Chartered Financial Consultant (ChFC). General Job Information Title Personal Financial Counselor, Assignment Ready Counselor, PFC, Wyoming Grade 23 Work Experience - Required Financial Counseling Work Experience - Preferred Education - Required A Combination of Education and Work Experience May Be Considered., Bachelor's Education - Preferred License and Certifications - Required AFC - Accredited Financial Counselor - EnterpriseEnterprise, CFP - Certified Financial Planner - EnterpriseEnterprise, ChFC - Chartered Financial Consultant - EnterpriseEnterprise, DL - Driver License, Valid In State - OtherOther License and Certifications - Preferred Salary Range Salary Minimum: $53,125 Salary Maximum: $84,995 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. Magellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live. Our strong culture of caring is the common thread in both our business strategy and our work environment. We value professional growth and development, total health and wellness, rewards and recognition as well as employee unity. Magellan is a place where you can thrive. Magellan is committed to providing equal employment opportunities to employees and applicants for employment without regard to race, color, creed, religion, sex, gender identity and expression, sexual orientation, marital status, age, national origin, ancestry, citizenship, physical or mental disability, disabled veteran or veteran of the Vietnam Era status, or any other factors protected by law. Magellan is committed to meeting applicable Federal labor and employment law posting requirements by providing necessary posters in a format which is easily accessible and conspicuous to all applicants. Copies of applicable posters are accessible by clicking here. Warning: Employment Scam It has come to our attention that a false representative is contacting potential candidates and offering them work at home positions with Magellan Health. “Interviews” are conducted completely through email and the false job offer includes the promise of a check to be issued to the candidate for the purposes of setting up a home office. Please know that Magellan Health does not interview any candidate through email, nor do we issue checks to candidates to set up home offices. All of our available positions are posted on legitimate job boards and our recruitment team directly contacts candidates should there be a fit. If you suspect you are being contacted by a false representative of Magellan Health, please call 410-953-2911

Analyze, evaluate, and redesign business and IT processes, collaborate with software engineers, and develop test strategies. | At least 2 years of experience in IT-related roles involving requirements development, testing, and familiarity with QA methodologies, SQL, and Agile. | Job Description: • Analyze, evaluate and redesign business, IT or operational processes using scientific approaches • Collaborate with Software Engineers to understand features and technical implementation • Independently participate in requirements documentation, business systems configuration and defining/execution of acceptance criteria • Document issues and participate in their resolution • Work closely with development and business teams to understand business requirements • Translate business needs into high-level technical specifications and design • Identify gaps and ensure deployment of solutions • Support business-critical systems using mature IT and software engineering practices • Develop, deploy, and execute test strategies • Test applications and products at the user level, both manually and with automated tools Requirements: • 2+ years related experience including developing requirements, designing and executing test cases in IT • Experience with QA methodology and problem solving techniques/tools. • Detail-oriented person who is passionate about quality and is enthusiastic about the new technology offered to customers. • Demonstrated software testing experience. • Excellent written and oral communication skills. • Meticulous attention to detail; the ability to juggle several tasks in parallel without lowering your quality bar. • Experience with analytical programming languages such as SQL. • Ability to thrive in ambiguity and rapid change. • Experience with process flow diagrams. • Experience with applying Agile Methods. Benefits: • Comprehensive benefits package • Health, life, voluntary and other benefits and perks

Supports team coordination, assists leadership with marketing and communication strategies, and manages content and editorial calendars. | Requires a bachelor's degree in marketing or communications, strong writing and organizational skills, and proficiency with Microsoft Office. | Job Description: • Provides team coordination support. • Assists leadership in marketing, social and communications strategy, planning and execution. • Collaborates with other departments and engages with key vendors in the development, production, and distribution of promotional materials. • Develops clear, concise and compelling content targeting a variety of audiences through Magellan`s key channels. • Supports the coordination of team activities including management of the editorial calendar. Requirements: • Bachelor’s degree in marketing, communications or related field. • Creative, quick thinker with strong writing, verbal and interpersonal communication skills. • Excellent project management and organizational skills. • Ability to multitask and prioritize accordingly. • Proactive and flexible self-starter with impeccable attention to detail. • Comfortable with Microsoft Office software programs and tools. Benefits: • Comprehensive benefits package • Health, life, voluntary and other benefits and perks

Authorize and review utilization of mental health and substance abuse services, assist with discharge planning, provide member assistance, and monitor care effectiveness. | Requires current relevant licensure, minimum 2 years post-degree healthcare experience in behavioral health or substance abuse settings, and knowledge of utilization management and DSM V. | Description: • Authorizes and reviews utilization of mental health and substance abuse services provided in inpatient and/or outpatient care settings. • Collects and analyzes utilization data. • Assists with discharge planning and care coordination. • Provides member assistance with mental health and substance abuse issues. • Monitors inpatient and/or outpatient level of care services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness. • Provides telephone triage, crisis intervention, and emergency authorizations as assigned. • Develops discharge plans and oversees their implementation in conjunction with providers and facilities. • Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and company policies and procedures. Requirements: • Licensure is required for this position, specifically a current license that meets State, Commonwealth or customer-specific requirements. • One or more of the following licensure is required for this role with necessary degrees: CEAP, LMSW, LCSW, LSW, LPC or RN. • Minimum 2 years experience post degree in healthcare, behavioral health, psychiatric and/or substance abuse health care setting. • Strong organization, time management and communication skills. • Knowledge of utilization management procedures, mental health and substance abuse community resources and providers. • Knowledge and experience in inpatient and/or outpatient setting. • Knowledge of DSM V or most current diagnostic edition. • Ability to analyze specific utilization problems, plan and implement solutions that directly influence quality of care. Benefits: • comprehensive benefits package • health, life, and voluntary benefits • wellness programs

Provide one-to-one peer support for youth with mental health or substance use needs and guide them in developing wellness plans. Maintain accurate documentation and participate in community outreach to engage youth in the peer support program. | Candidates must be self-identified individuals in recovery with lived experience in youth mental health or substance use services and have completed training as a Youth Peer Support Specialist. A reliable vehicle for community travel and strong communication skills are also required. | Work remote from home in the Las Cruces area with extensive community based travel. This position provides non-clinical, evidence-based peer support services, serves as a youth advocate, shares coping skills, and provides recovery information for youth members ages 14 - 21. This position performs a wide range of tasks designed to assist youth members in developing independence through individual recovery planning, wellness self-management, and strengthening resilience to improve personal health outcomes. This position will role model competency in recovery, resiliency, and wellness practices. Direct Peer Support & Recovery Planning: Provide one-to-one peer support for youth with mental health or substance use needs. Guide youth in developing wellness plans using an evidence-based framework. Facilitate use of the 8 Dimensions of Wellness to set whole-health goals. Assist with transitions from inpatient, residential, and alternative care settings to community-based recovery supports. Support youth in building empowerment, self-advocacy, and problem-solving skills and maintaining progress toward recovery through community participation and role modeling wellness. (50%) Administrative Responsibilities: Maintain accurate, timely, and complete documentation to ensure records meet compliance, audit, and reporting requirements. Participate in supervision, training, and ongoing professional development. Travel within the community to meet youth members. (40%) Engagement & Education: Initiate proactive outreach to youth to build engagement and facilitate successful enrollment into the peer support program. Educate providers, internal staff, and youth on resiliency and recovery practices. (10%) Other Job Requirements Responsibilities Self-identified person in recovery with lived experience of youth/young adult mental health or substance use services. Completed training and certification as a Youth Peer Support Specialist. Reliable vehicle and ability to travel in the community. Working knowledge of Microsoft Office Suite and comfort using mobile apps and web-based platforms. Strong interpersonal, verbal, and written communication skills. Ability to document accurately and maintain timely records. Knowledge of local mental health, substance use and community systems, recovery and resiliency principles, wrapround, and tools such as wellness planning and the 8 dimensions of wellness. Experience representing member strengths and needs in clinical or interdisciplinary settings. Ability to analyze complex situations and make independent decisions. Proven ability to work both independently and as part of a team in a fast-paced environment. General Job Information Title Youth Support Navigator - Certified Youth Peer Support Specialist Grade 19 Work Experience - Required Lived Experience With Mental Health/Substance Use Recovery, Peer Specialist Work Experience - Preferred Education - Required GED, High School Education - Preferred Associate, Bachelor's License and Certifications - Required YPSS - Youth Peer Support Specialist - Care Mgmt License and Certifications - Preferred Salary Range Salary Minimum: $37,725 Salary Maximum: $56,595 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. Magellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live. Our strong culture of caring is the common thread in both our business strategy and our work environment. We value professional growth and development, total health and wellness, rewards and recognition as well as employee unity. Magellan is a place where you can thrive. Magellan is committed to providing equal employment opportunities to employees and applicants for employment without regard to race, color, creed, religion, sex, gender identity and expression, sexual orientation, marital status, age, national origin, ancestry, citizenship, physical or mental disability, disabled veteran or veteran of the Vietnam Era status, or any other factors protected by law. Magellan is committed to meeting applicable Federal labor and employment law posting requirements by providing necessary posters in a format which is easily accessible and conspicuous to all applicants. Copies of applicable posters are accessible by clicking here. Warning: Employment Scam It has come to our attention that a false representative is contacting potential candidates and offering them work at home positions with Magellan Health. “Interviews” are conducted completely through email and the false job offer includes the promise of a check to be issued to the candidate for the purposes of setting up a home office. Please know that Magellan Health does not interview any candidate through email, nor do we issue checks to candidates to set up home offices. All of our available positions are posted on legitimate job boards and our recruitment team directly contacts candidates should there be a fit. If you suspect you are being contacted by a false representative of Magellan Health, please call 410-953-2911

The Youth Support Navigator provides non-clinical, evidence-based peer support services to youth members aged 14-21, assisting them in developing independence through recovery planning and wellness self-management. Responsibilities include direct peer support, administrative tasks, and proactive outreach to engage youth in the peer support program. | Candidates must be self-identified individuals in recovery with lived experience in youth mental health or substance use services and have completed training as a Youth Peer Support Specialist. A reliable vehicle for community travel and strong communication skills are also required. | Remote work from home in the Albuquerque area or surrounding area. Extensive community based travel. This position provides non-clinical, evidence-based peer support services, serves as a youth advocate, shares coping skills, and provides recovery information for youth members ages 14 - 21. This position performs a wide range of tasks designed to assist youth members in developing independence through individual recovery planning, wellness self-management, and strengthening resilience to improve personal health outcomes. This position will role model competency in recovery, resiliency, and wellness practices. Direct Peer Support & Recovery Planning: Provide one-to-one peer support for youth with mental health or substance use needs. Guide youth in developing wellness plans using an evidence-based framework. Facilitate use of the 8 Dimensions of Wellness to set whole-health goals. Assist with transitions from inpatient, residential, and alternative care settings to community-based recovery supports. Support youth in building empowerment, self-advocacy, and problem-solving skills and maintaining progress toward recovery through community participation and role modeling wellness. (50%) Administrative Responsibilities: Maintain accurate, timely, and complete documentation to ensure records meet compliance, audit, and reporting requirements. Participate in supervision, training, and ongoing professional development. Travel within the community to meet youth members. (40%) Engagement & Education: Initiate proactive outreach to youth to build engagement and facilitate successful enrollment into the peer support program. Educate providers, internal staff, and youth on resiliency and recovery practices. (10%) Other Job Requirements Responsibilities Self-identified person in recovery with lived experience of youth/young adult mental health or substance use services. Completed training and certification as a Youth Peer Support Specialist. Reliable vehicle and ability to travel in the community. Working knowledge of Microsoft Office Suite and comfort using mobile apps and web-based platforms. Strong interpersonal, verbal, and written communication skills. Ability to document accurately and maintain timely records. Knowledge of local mental health, substance use and community systems, recovery and resiliency principles, wrapround, and tools such as wellness planning and the 8 dimensions of wellness. Experience representing member strengths and needs in clinical or interdisciplinary settings. Ability to analyze complex situations and make independent decisions. Proven ability to work both independently and as part of a team in a fast-paced environment. General Job Information Title Youth Support Navigator - Certified Youth Peer Support Specialist Grade 19 Work Experience - Required Lived Experience With Mental Health/Substance Use Recovery, Peer Specialist Work Experience - Preferred Education - Required GED, High School Education - Preferred Associate, Bachelor's License and Certifications - Required YPSS - Youth Peer Support Specialist - Care Mgmt License and Certifications - Preferred Salary Range Salary Minimum: $37,725 Salary Maximum: $56,595 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. Magellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live. Our strong culture of caring is the common thread in both our business strategy and our work environment. We value professional growth and development, total health and wellness, rewards and recognition as well as employee unity. Magellan is a place where you can thrive. Magellan is committed to providing equal employment opportunities to employees and applicants for employment without regard to race, color, creed, religion, sex, gender identity and expression, sexual orientation, marital status, age, national origin, ancestry, citizenship, physical or mental disability, disabled veteran or veteran of the Vietnam Era status, or any other factors protected by law. Magellan is committed to meeting applicable Federal labor and employment law posting requirements by providing necessary posters in a format which is easily accessible and conspicuous to all applicants. Copies of applicable posters are accessible by clicking here. Warning: Employment Scam It has come to our attention that a false representative is contacting potential candidates and offering them work at home positions with Magellan Health. “Interviews” are conducted completely through email and the false job offer includes the promise of a check to be issued to the candidate for the purposes of setting up a home office. Please know that Magellan Health does not interview any candidate through email, nor do we issue checks to candidates to set up home offices. All of our available positions are posted on legitimate job boards and our recruitment team directly contacts candidates should there be a fit. If you suspect you are being contacted by a false representative of Magellan Health, please call 410-953-2911

The Network Management Specialist will create and maintain behavioral health provider contracts for Medicaid, Medicare, and Commercial lines of business in New Mexico. This role involves managing contract updates, ensuring compliance with regulations, and collaborating with internal departments to maintain network accuracy. | Candidates should have a minimum of 1 year of experience in a related field and knowledge of NCQA requirements. Strong skills in Microsoft Office, particularly Excel and PowerPoint, are also required. | 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 SOS 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. Assesses network needs, analyzes network composition, and using organization databases, application of regulatory requirements, accreditation entities and other resources, recruits individual, group and/or organizational providers to meet network adequacy standards and assure quality network. Conducts and coordinates contracting and amendment initiatives. Provides issue resolution and complex trouble shooting for providers. Conducts provider education and provider relation activities, providing necessary written materials. Conducts administrative provider site visits and coordinates report development and completion according to contractual requirements or ad hoc requests. Coordinates 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. Conducts and manages ongoing audits of provider compliance with Magellan policies and procedures as well as contractual obligations for multiple customers. Develops work plans to address audit requirements. Works 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 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. Magellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live. Our strong culture of caring is the common thread in both our business strategy and our work environment. We value professional growth and development, total health and wellness, rewards and recognition as well as employee unity. Magellan is a place where you can thrive. Magellan is committed to providing equal employment opportunities to employees and applicants for employment without regard to race, color, creed, religion, sex, gender identity and expression, sexual orientation, marital status, age, national origin, ancestry, citizenship, physical or mental disability, disabled veteran or veteran of the Vietnam Era status, or any other factors protected by law. Magellan is committed to meeting applicable Federal labor and employment law posting requirements by providing necessary posters in a format which is easily accessible and conspicuous to all applicants. Copies of applicable posters are accessible by clicking here. Warning: Employment Scam It has come to our attention that a false representative is contacting potential candidates and offering them work at home positions with Magellan Health. “Interviews” are conducted completely through email and the false job offer includes the promise of a check to be issued to the candidate for the purposes of setting up a home office. Please know that Magellan Health does not interview any candidate through email, nor do we issue checks to candidates to set up home offices. All of our available positions are posted on legitimate job boards and our recruitment team directly contacts candidates should there be a fit. If you suspect you are being contacted by a false representative of Magellan Health, please call 410-953-2911

The Lead Customer Experience Associate serves as a subject matter expert and customer advocate, supporting staff and clients in a healthcare environment. Responsibilities include handling escalated calls, mentoring team members, and ensuring compliance with policies and procedures. | Candidates must have 5+ years of call center or customer service experience, with 2-3 years specifically in a Magellan call center. Healthcare experience is required, along with strong people management skills and the ability to navigate multiple computer applications. | Subject Matter Expert (SME) customer advocate role supporting staff, clients, members, providers. This is a leadership support position providing assistance with all aspects of our programs, policies, and procedures. Responsibilities include handling escalated incoming/outgoing calls and acting as a resource for staff inquiries. Overall expectations are to support the team to provide outstanding service and strive to resolve callers’ needs on the first call. Performance expectations are to meet and exceed customers’ expectations and our quality standards. Additional responsibilities include supporting team members, processes and/or projects. Serves as primary resource to team of customer care associates and supports services to ensure compliance with policies, procedures, and customer requirements. Conducts call evaluations and coaching, providing constructive feedback sessions per department standards. Serves as a subject matter expert (SME) and a member of the Customer Care Leadership Team, when involved in various projects, initiatives and/or meetings. Mentors new staff and coaches staff on improvement plans as well as motivates and encourages team member to excel. Supports a team environment that contributes to a high degree of employee satisfaction and engagement. Supports new hire activities (i.e. “nesting” efforts, participating in new hire training). Reviews and analyzes metrics (daily, weekly, monthly) for staff to ensure compliance, identify trends and implement action plans to address issues. Facilitates aspects of the complaints and grievance process. Supports planning and roll out efforts of new initiatives. Partners with customer care quality department to support service quality improvement programs and employee development, ensuring member and provider satisfaction. Assists in various projects (e.g., Participating or managing User Acceptance Testing (UAT) plans and various health plan initiatives, etc.). Gathers data, reporting and completes initial analysis and trending, as needed. Consults with the Manager and/or Director for complex business decisions. Supports planning and roll out efforts of new initiatives. Ability to identify, share, and implement best practices across this organization. Attends and presents data, addresses issues in customer-facing and team meetings, as needed. Oversees back-office staff to ensure workload is completed timely. Oversees team chats to answer questions, provide resources and ensure appropriate content. 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 5+ years of call center/customer service experience; 2-3 years of Magellan call center experience; healthcare experience is required. Must be flexible in scheduling and comfortable with change as customer service is an ever-changing environment. Responsible for meeting personal call handling requirements and daily telephone standards as set forth by management. Must agree to observing service for the purpose of training and quality control. Expert with keyboard functions navigation between multiple computer applications. Must be able to maneuver expertly through various computer platforms while verifying information on all calls. Must possess an attitude of service excellence. Displays sound people management skills. Experience in departmental products and processes. General Job Information Title Lead Customer Experience Associate, Healthcare Grade 20 Work Experience - Required Call Center, Customer Service, Healthcare Work Experience - Preferred Education - Required GED, High School Education - Preferred Associate, Bachelor's License and Certifications - Required License and Certifications - Preferred Salary Range Salary Minimum: $41,505 Salary Maximum: $62,255 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. Magellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live. Our strong culture of caring is the common thread in both our business strategy and our work environment. We value professional growth and development, total health and wellness, rewards and recognition as well as employee unity. Magellan is a place where you can thrive. Magellan is committed to providing equal employment opportunities to employees and applicants for employment without regard to race, color, creed, religion, sex, gender identity and expression, sexual orientation, marital status, age, national origin, ancestry, citizenship, physical or mental disability, disabled veteran or veteran of the Vietnam Era status, or any other factors protected by law. Magellan is committed to meeting applicable Federal labor and employment law posting requirements by providing necessary posters in a format which is easily accessible and conspicuous to all applicants. Copies of applicable posters are accessible by clicking here. Warning: Employment Scam It has come to our attention that a false representative is contacting potential candidates and offering them work at home positions with Magellan Health. “Interviews” are conducted completely through email and the false job offer includes the promise of a check to be issued to the candidate for the purposes of setting up a home office. Please know that Magellan Health does not interview any candidate through email, nor do we issue checks to candidates to set up home offices. All of our available positions are posted on legitimate job boards and our recruitment team directly contacts candidates should there be a fit. If you suspect you are being contacted by a false representative of Magellan Health, please call 410-953-2911

Provide assistance to members and providers regarding programs, policies, and procedures while handling incoming calls related to eligibility, benefits, claims, and authorization of services. Strive to resolve member and provider needs on the first call while maintaining confidentiality and meeting performance expectations. | 1-2 years of customer service experience is required, with a preference for call center and healthcare experience. Candidates must be flexible with scheduling and comfortable with change in a dynamic customer service environment. | This position is a front-line service position providing assistance to Magellan's members and providers 24 hours a day 7 days a week regarding programs, policies, and procedures. Responsibilities include answering incoming calls related to eligibility, benefits, claims and authorization of services from members or providers. Responsibilities also include the administration of intake documentation into the appropriate systems. Overall expectations are to provide outstanding service to internal and external customers and strive to resolve member and provider needs on the first call. Performance expectations are to meet or exceed operations production and quality standards. Scheduled work hours are determined based on business need which could include normal business hours, evenings, and weekends. Customer advocate role supporting our members and providers, facilitating care and service. This is a service position providing assistance to Magellan's members, providers, and clients regarding various aspects of our programs, policies, and procedures. Responsibilities include handling incoming/outgoing calls related to healthcare related benefits. Responsibilities also include the administration of intake documentation into the appropriate systems. Overall expectations are to provide outstanding service to internal and external customers and strive to resolve callers’ needs on the first call. Performance expectations are to meet and/or exceed customers’ expectations and our quality standards. Researches, articulately communicates medical information regarding a variety of services including: educating providers on claims, member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality/Protected Health Information (PHI.). Meets key performance indicators and service standards while showing compassion to members and providers per Magellan’s values and mission. Identifies and responds to crisis calls with appropriate resource. Facilitates routine referrals and triage decisions not requiring clinical judgment. Comprehensively assembles and enters patient information into the appropriate delivery system. Demonstrates flexibility in areas such as job duties and schedule to aid in better serving members and help Magellan achieve its business and operational goals. Supports team members and participate in activities to help build a high-performance team. Assumes full responsibility for self-development and career progression; proactively seek and participate in ongoing training sessions (formal and informal). Responsible for staying abreast of operational changes, updating self to ensure accuracy. Assists efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies. Leads or participates in activities as requested that help improve Care Center performance, quality, and culture. Navigate Magellan’s systems, document customers' comments/information and forwards required information. Responsible for reading and retaining information disseminated through multiple resources, ensuring calls are addressed accurately and appropriately per account information. Other Job Requirements Responsibilities 1- 2 or more years of customer service experience. Must be able to talk and type simultaneously, with attention to detail. Must be flexible in scheduling and comfortable with change as customer service is an ever-changing environment. Responsible for meeting monthly individual call center metrics. Must agree to recording and evaluations for training and compliance. Must be proficient with keyboard functions and navigation between multiple computer applications General Job Information Title Customer Experience Associate I, Healthcare Grade 17 Work Experience - Required Customer Service Work Experience - Preferred Call Center, Healthcare Education - Required GED, High School Education - Preferred Associate, Bachelor's License and Certifications - Required License and Certifications - Preferred Salary Range Salary Minimum: $31,175 Salary Maximum: $46,765 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. Magellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live. Our strong culture of caring is the common thread in both our business strategy and our work environment. We value professional growth and development, total health and wellness, rewards and recognition as well as employee unity. Magellan is a place where you can thrive. Magellan is committed to providing equal employment opportunities to employees and applicants for employment without regard to race, color, creed, religion, sex, gender identity and expression, sexual orientation, marital status, age, national origin, ancestry, citizenship, physical or mental disability, disabled veteran or veteran of the Vietnam Era status, or any other factors protected by law. Magellan is committed to meeting applicable Federal labor and employment law posting requirements by providing necessary posters in a format which is easily accessible and conspicuous to all applicants. Copies of applicable posters are accessible by clicking here. Warning: Employment Scam It has come to our attention that a false representative is contacting potential candidates and offering them work at home positions with Magellan Health. “Interviews” are conducted completely through email and the false job offer includes the promise of a check to be issued to the candidate for the purposes of setting up a home office. Please know that Magellan Health does not interview any candidate through email, nor do we issue checks to candidates to set up home offices. All of our available positions are posted on legitimate job boards and our recruitment team directly contacts candidates should there be a fit. If you suspect you are being contacted by a false representative of Magellan Health, please call 410-953-2911