Remote Senior Manager, Provider Credentialing & Admin

Health Care Service Corp.; United States; Remote; USD 93,000 - 168,000; Full time

Job summary

Health Care Service Corporation seeks an experienced credentialing leader to manage the credentialing process in compliance with DOI, CMS, DOD/TriCare, NCQA and URAC. You will develop policies, procedures, workflows and department goals, ensuring operational effectiveness and resource allocation.

Lead monthly Provider Network Committee and quarterly Institutional Provider Workgroup with senior leaders from across the Enterprise.

Qualifications

• Bachelor’s degree and 7 years’ experience in managed care provider contracting, network management or credentialing, or 11 years’ experience in the same with 3+ years in management.
• Must have management experience and ability to lead, coach and train staff.
• Strong knowledge of state and federal regulations, NCQA/URAC/CMS requirements and quality concepts.
• Proven ability to develop policies, procedures and workflows and improve operations.

Responsibilities

• Oversee credentialing processes in compliance with agency regulations (DOI, CMS, DOD/TriCare, NCQA, URAC).
• Develop, implement and maintain policies, procedures, and workflows to meet or exceed goals.
• Lead committees and collaborate with leaders to address issues and improve processes.

Skills

Management experience

Coaching and training

Regulatory knowledge

Communication skills

Education

Bachelor’s Degree in a related field

Job description

Health Care Service Corporation seeks an experienced credentialing leader to manage the credentialing process in compliance with DOI, CMS, DOD/TriCare, NCQA and URAC. You will develop policies, procedures, workflows and department goals, ensuring operational effectiveness and resource allocation.

Lead monthly Provider Network Committee and quarterly Institutional Provider Workgroup with senior leaders from across the Enterprise.