Credentialing Manager

🕒 Outubro 12

🇺🇸 Estados Unidos – Remoto (EUA)

⏰ Tempo Integral

🟠 Sênior

🔴 Especialista

👔 Gerente

👻 Score fantasma 15%

O que significa: a chance de ninguém estar realmente contratando para esta vaga.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Por que essa pontuação:

• Aberta há 30 dias.
• As vagas desta empresa costumam ser preenchidas em 21 dias.
• Sem salário divulgado.

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Encontrar Vagas Remotas Similares

Curana Health

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

🏥 Saúde

🤝 B2B

⚕️ Seguro de Saúde

Healthcare • B2B • Healthcare Insurance

A Curana Health é uma provedora de serviços de saúde focada em cuidados primários para idosos e serviços clínicos no local em comunidades de enfermagem especializada e moradias para idosos. A empresa faz parcerias com operadores, pagadores e planos Medicare Advantage para implementar modelos de cuidado baseado em valor, oferecendo equipes de cuidados lideradas por médicos, serviços de diretores médicos, coordenação de cuidados (incluindo RPM e APCM), saúde comportamental e cuidados paliativos. A Curana enfatiza a redução de readmissões hospitalares, quedas e polifarmácia, ao mesmo tempo em que melhora a satisfação dos residentes por meio de um cuidado integrado, baseado na comunidade, apoiado por tecnologia e parcerias com pagadores.

Descrição

• Lead and oversee the full practitioner credentialing and recredentialing process in alignment with CMS, NCQA, state, Medicaid, and insurance requirements • Manage and support a team of credentialing professionals responsible for professional provider credentialing • Monitor provider file inventory, team workflows, production benchmarks, quality assurance, and credentialing turnaround times • Establish tracking and reporting processes for provider status, team performance, credentialing volume, and potential risks • Develop, implement, and maintain credentialing policies and procedures • Identify inefficiencies and lead process-improvement initiatives • Maintain accurate provider status information in provider data management and credentialing systems • Oversee credentialing correspondence, approvals, denials, information requests, and provider follow-up • Partner with data management and IT teams on credentialing system integration and operational improvements • Research and resolve credentialing issues and prevent recurrence • Maintain Credentialing Committee documentation, manage meeting agendas, and present credentialing recommendations • Communicate credentialing status changes to providers and internal stakeholders • Oversee provider outreach, application submission, documentation, and internal quality-assurance processes • Train and support team members, Medical Directors, and health plan partners on credentialing processes and tools

🎯 Requisitos

• Bachelor’s degree or an equivalent combination of education and relevant healthcare experience • Minimum of 7 years of experience in a managed care organization or large health plan environment • Minimum of 5 years of direct provider credentialing and contracting experience • Demonstrated experience leading provider credentialing operations and managing team performance • Strong knowledge of physician credentialing standards and requirements established by CMS, NCQA, state agencies, and Medicaid programs • Experience using CredentialStream or a comparable credentialing platform • Proficiency with Excel and SharePoint • Proven experience managing high-volume credentialing workflows, provider file inventory, quality metrics, and operational deadlines • Experience building, improving, or repairing credentialing processes and tracking systems • Strong reporting and analytical skills, including the ability to track and interpret credentialing trends and performance • Excellent written and verbal communication skills, with the ability to work effectively across organizational levels and with external partners • Proficiency with Microsoft Office applications and credentialing management systems • Experience working for a national or regional managed care organization or large health plan (preferred) • Experience performing SQL-related processes or working with SQL-supported reporting (preferred) • Interest in using AI, automation, bots, or agents to improve operational efficiency (preferred) • Demonstrated success implementing process improvements in a complex, high-volume credentialing environment (preferred) • Must be able to work in the United States; visa sponsorship is unavailable

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