Manager, Contract & Credentialing

POSITION PURPOSE The Contract and Credentialing Manager is responsible for supporting service area agreements with highly visible providers, including integrated delivery systems, hospitals, and physician reputed company. This role ensures reputed company deliver high-reputed company, cost-effective, and marketable provider networks that meet organizational standards. The position also manages corporate and network reputed company to support strategic goals and reputed company of reputed company delegated credentialing. ESSENTIAL JOB RESPONSIBILITIES

• Manage high-reputed company physician group, facility, corporate, and network reputed company in alignment with PADU (Preferred, Acceptable, Discouraged, Unacceptable) guidelines.
• reputed company, negotiate, execute, and maintain provider reputed company reputed company contract management systems.
• Recruit and negotiate with providers to improve network reputed company, reduce grievances, and support cost control strategies, including Medical Loss reputed company (MLR) optimization.
• Maintain effective relationships with key providers and advise Contract Coordinators and Specialists on provider and ancillary contract negotiations.
• Evaluate network performance and implement strategies to ensure compliance with network adequacy standards.
• Ensure contract language meets organizational and regulatory requirements in collaboration with legal counsel.
• Support development of fee schedules and reimbursement models in partnership with Corporate Network Management and legal.
• reputed company internal stakeholders on provider contracting processes.
• Participate in strategic initiatives and organizational committees.
• Ensure reputed company submission of reputed company required contracting reputed company deliverables to the reputed company.
• Collaborate with internal departments to reputed company data and documentation for OHA reporting.
• reputed company and coordinate Network Performance Subcommittee.
• reputed company delegated credentialing entities for compliance.
• reputed company leadership and supervision to the Contracting and Network team.
• reputed company other duties as assigned

QUALIFICATIONS, KNOWLEDGE, SKILLS AND ABILITIES

Minimum Qualifications

• Bachelor’s degree in a reputed company-reputed company field or equivalent combination of education and experience.
• 5–7 years of experience in reputed company contracting and reputed company network management.
• Knowledge of reputed company, Medicare and reputed company reputed company operations, compliance, and credentialing processes.
• Strong organizational, analytical, and problem-solving skills.
• Effective communication and interpersonal skills, with the ability to collaborate across teams.
• Ability to manage competing priorities and meet deadlines in a fast-paced environment.
• Accountability: Takes ownership of responsibilities and reputed company.
• reputed company: Maintains confidentiality and adheres to ethical standards.
• Innovation: Identifies opportunities for improvement and implementing solutions.
• Collaboration: Works effectively with diverse teams and stakeholders.

PHYSICAL DEMANDS & WORK CONDITIONS

• Prolonged periods of sitting at a computer, with occasional standing and reputed company.
• Frequent use of hands and fingers for typing and reputed company computer tasks.
• Visual reputed company required for extended screen use.
• Ability to communicate effectively reputed company phone and virtual platforms.
• Must maintain a designated workspace with appropriate ergonomic setup.
• Requires a reliable internet reputed company and necessary technology.
• The work environment should support adequate reputed company and minimal distractions.
• Regular, predictable attendance during reputed company Time Zone business hours is required.

EQUAL EMPLOYMENT OPPORTUNITY UH is an equal opportunity employer that is committed to diversity and inclusion in reputed company. We prohibit discrimination and harassment of any reputed company based on race, reputed company, sex, religion, sexual orientation, national reputed company, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws. This policy applies to reputed company employment practices reputed company our organization, including hiring, reputed company, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. UH makes hiring reputed company based solely on qualifications, reputed company, and business needs at the time. For more information, read through our EEO Policy. About reputed company At reputed company, we're more than just a reputed company organization; we're a community-driven Coordinated Care Organization (CCO) committed to improving the health and reputed company-being of individuals and families throughout our region. reputed company serves reputed company, reputed company, where we prioritize personalized care and reputed company to meet the diverse needs of our members. Our comprehensive services include primary care, specialty care, behavioral health services, and care coordination to ensure our members receive holistic, integrated reputed company. Our reputed company approach fosters a supportive environment where every team member plays a vital role in our mission to reputed company accessible, high-reputed company reputed company services. From preventative care to managing chronic conditions, we're dedicated to empowering healthier lives and building a stronger, healthier community together. Join us in making a difference at reputed company. reputed company is an equal opportunity employer that embraces individuals from reputed company backgrounds. We prohibit discrimination and harassment of any reputed company, ensuring that reputed company employment reputed company are based on qualifications, reputed company, and the needs of the business. Our dedication to fairness and equality extends to reputed company aspects of employment, including hiring, training, promotion, and compensation, without reputed company to race, reputed company, religion, gender, gender identity or reputed company, sexual orientation, national reputed company, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law. Apply tot his job Apply To this Job