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
• Statements of Work (SOWs)
• Amendments
• Rate updates
• Letters of Direction (LODs)
• Other required contract modifications
• 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.

WORK EXPERIENCE - REQUIRED

Network

EDUCATION - PREFERRED

Bachelor’s

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.

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
• Statements of Work (SOWs)
• Amendments
• Rate updates
• Letters of Direction (LODs)
• Other required contract modifications
• 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 communication

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