Senior Manager, Licensing and Credentialing

Vaga não está no LinkedIn

🕒 4 dias atrás

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $100.000 - $113.000 / ano

⏰ Tempo Integral

🟠 Sênior

👔 Gerente

👻 Score fantasma 3%

O que significa: quão provável esta vaga está aberta sem contratação ativa.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Como pontuamos: tempo em aberto, republicações, vagas abertas vs tamanho do time, rapidez para fechar vagas, e se o salário está divulgado.Observação: é uma estimativa de dados públicos, não um julgamento da empresa. Vagas reais podem ter pontuação alta, então use como uma dica, não como um fato.

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Author Health

SiteLinkedInTodas as Vagas

51 - 200 funcionários

Fundada em 2023

💼 Consultoria

🛡️ Seguros

🏥 Saúde

💰 $115.000.000 Series A - Author Health em 2023-06

Consulting • Insurance • Healthcare

A Author Health é um fornecedor de serviços coordenados de saúde comportamental que oferece serviços de gerenciamento de assistência e saúde mental baseados em equipe para pessoas com necessidades complexas de saúde mental, incluindo demência, depressão e ansiedade severas, transtorno bipolar, TEPT, esquizofrenia e transtornos por uso de substâncias. Eles combinam psiquiatria virtual, enfermeiros especializados, assistentes sociais clínicos licenciados e gerentes de cuidado presenciais para integrar o cuidado clínico com serviços comunitários e parceiros de seguros (incluindo planos Medicare e Medicare Advantage), focando no cuidado integral da pessoa, compartilhamento de informações em conformidade com HIPAA e melhoria da qualidade de vida.

Descrição

• Develop and execute a proactive licensing and credentialing program aligned with clinician volume, target states, payer panels, growth goals, and launch timelines • Own and manage the delegated credentialing function in compliance with NCQA standards and payer requirements • Manage licensing and credentialing vendors, including performance, accountability, and contract compliance • Serve as the operational liaison between vendors and clinicians, resolving bottlenecks and ensuring a smooth clinician experience • Partner with Compliance on payer audits, OIG and SAM exclusion reporting for external vendors, and regulatory filings • Lead the NCQA certification process to bring licensing and credentialing in-house • Track and execute state license renewals, DEA registrations, and payer re-credentialing • Direct creation, attestation, and maintenance of clinician CAQH profiles • Ensure accurate provider roster submissions to health plans • Own the credentialing vendor platform, data integrity, secure document retention, and workflow automation • Modernize workflows using AI, automation, and emerging technologies • Establish and report KPIs to executive leadership, including turnaround times, defect rates, and vendor SLA adherence • Work with leadership, clinical teams, and vendors to build a scalable, reliable function • Manage tasks and communications using virtual tools in a remote work environment

🎯 Requisitos

• Direct experience managing delegated credentialing programs, including NCQA standards, payer delegated agreements, and multi-state licensing requirements • Proven track record leveraging AI, automation, or continuous improvement methodologies • Experience managing credentialing and licensing vendors • Experience hiring, leading, and performance managing teams • Experience scaling licensing and credentialing functions in a startup or fast-growth healthcare or telehealth environment • Operational fluency in clinical, care management, and data exchange processes common in value-based care or telehealth organizations • Exceptional communication and influencing skills • Strong project management skills and ability to manage multiple workstreams • 5–7 years of experience in licensing and credentialing • 3+ years of direct experience managing credentialing and/or licensing functions, including delegated credentialing programs • Experience working with Medicare, Medicare Advantage, and Medicaid programs • Experience in a telehealth or multi-state provider environment strongly preferred • Proficiency in credentialing and provider data management software • Bachelor's degree in a related field or equivalent experience required • Advanced degree or professional certifications, such as CPCS or CPMSM from NAMSS, strongly preferred • Ability to sit for extended periods in front of a computer screen • Ability to lift up to ten pounds

🏖️ Benefícios

• Fully remote work-from-home position • Company-provided equipment • Very limited travel • Inclusive and accessible applicant experience • Workplace accommodations available throughout the hiring process