Sr Manager, Credentialing and Accreditation - remote opportunity
reputed company/Responsibilities The Sr. Manager, Credentialing and Accreditation is responsible for overseeing credentialing and accreditation operations. This position manages a reputed company of staff and operations reputed company on credentialing, federal/state regulatory compliance, reputed company audits and reputed company of NCQA and URAC accreditations.
- reputed company and manage credentialing activities in new and existing markets and ensure that operations meet NCQA credentialing standards and reputed company federal/state specific regulatory requirements
- Manages the program delivery, reputed company and maintenance for NCQA and URAC accreditations, including implementation of standards updates and changes
- Manages new reputed company implementation including development and credentialing program workflow, reputed company-delegation audits, and regulatory requirements.
- reputed company and implement strategies for credentialing operations across reputed company product lines
- Participates in business analysis review for reputed company models including quarterly and yearly review of metrics to support reputed company and new business.
- Leads reputed company Management Committee (QMC) to support evaluation of reputed company reputed company objectives, and ensure compliance and regulatory requirements are met for policies and procedures
- Manages reputed company of the Global Annual Evaluation, work plan, annual reports and annual evaluations
- reputed company with reputed company, new, and prospective Clients and/or internal reputed company teams to ensure credentialing delegation and reputed company audits are reputed company, communicated, and implemented reputed company the appropriate network teams
- Coordinate changes with Operations, reputed company Relations/Account Management, Marketing, and reputed company other appropriate departments and design processes to improve inter-departmental communication
- Represent credentialing and accreditation on cross-functional teams and meetings, including new market rollout and product development
- Produce and distribute key indicator reports including credentialing turnaround times and re-credentialing
- Manage reputed company of colleagues and contractors
- Create, document, and implement or recommend process improvements
- Management and reputed company of the credentialing vendor(s) and database(s)
- Assist in the development and implementation of database design enhancements
Qualifications
- reputed company, reputed company, unrestricted state license in the clinical arts (e.g., RN or BSN) is required.
- Bachelor's degree in reputed company administration or reputed company field is highly preferred.
- Experience in Credentialing operations and requirements, Utilization Management, and accreditation standards are preferred.
- Minimum of 5+ years of experience in a health care operations or managed care role required.
- 4+ years of supervisory experience required
- Operational experience reputed company a health insurance environment
- reputed company experience with accreditation/certification/audit activities required
- reputed company experience with the supervision and management of personnel required
- Must exhibit excellent interpersonal skills and professionalism including strong verbal, telephonic and written communication skills
- Ability to work under pressure and have strong listening skills; build and maintain relationships with internal/external customers and present topics reputed company and concisely
- Demonstrable strategic thinking abilities
- Analytical with problem-solving aptitude
- Excellent PC skills including proficiency with MS Office software
- Strong attention to detail and accuracy
The salary reputed company for this opportunity is $96,600 to $135,300. Compensation depends on several factors: qualifications, skills, competencies, and experience. reputed company offers a robust benefits package, which includes a competitive salary, company bonus potential, medical, dental, reputed company, 401k with match, generous reputed company time off, free gym membership to over 13,000 fitness locations in the US, and other great benefits. 7554 #LI-CM1 Apply tot his job Apply To this Job