Credentialing Manager (Practitioner)

San Diego, CA 92121

Post Date: 05/22/2018 Job ID: 42729 Profession: Medical Management

Manager of Practitioner Credentialing

Our client, a large, nation-wide health plan, is seeking a Manager of Credentialing to oversee the Practitioner Contract Administration Staff to ensure that the department meets all performance standards. The Manager of Credentialing maintains compliance with NCQA and URAC standards and business objectives as it relates to Practitioner Contract Administration and Services departments.

Position Summary:

  • Responsible for maintaining corporate objectives through the credentialing and maintenance of the company network of practitioners.
  • Supervise and train practitioner credentialing examiners, primary verification examiners, and front end examiners, supervisors and team leads.
  • Create and revise credentialing policies, procedures, and workflows to ensure compliance with all regulatory accreditation, health plan delegation and contractual credentialing requirements.
  • Plan, assign, supervise and evaluate the work of others, monitor goals, objectives, deadlines and priorities.
  • Strong knowledge of Credentialing/re-credentialing, delegation oversight, NCQA, URAC and managed care experience (Medicaid, Medicare, and Commercial) required.

Qualifications:

  • 5 years of related experience in managed care or health services, at least 2 years of Supervisory/Management experience required
  • Bachelor Degree in related field preferred
  • Certified Provider Credentialing Specialist (CPCS) preferred
  • Familiarity with specialty health plans (HMO, PPO, POS and related plans)
  • Proficient with Microsoft Office, including Access, Word, Excel and Power Point
  • Preferred knowledge of CAQH

Why Work Here:

  • This is a direct-hire, permanent position with Mon-Fri schedule, standard business hours with solid base salary, bonus option, and comprehensive benefits package!
  • Growing, nationally-recognized healthcare organization
  • Employee-centric environment in a top-place to work
  • Opportunities for advancement within an established organization in a rapidly growing industry

Please submit your resume to learn more about the company!


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