Licensing and Credentialing Manager

September 21

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Nuvem

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Healthcare Insurance • Pharmaceuticals

Nuvem is a company that empowers covered entities by providing holistic solutions for pharmacy management and the 340B program. They aim to positively impact patient health and financial outcomes by offering technology and expertise in managing pharmacy programs, maintaining compliance, and achieving clinical objectives. Nuvem supports health centers of all sizes, helping them navigate the complexities of the 340B program, manufacturer restrictions, and claim capture to focus on providing high-quality care. Their services include pharmacy management, clinical programs, patient engagement, and outsourced 340B management. They pride themselves on being a comprehensive solution for client and compliance support in the healthcare sector.

201 - 500 employees

⚕️ Healthcare Insurance

💊 Pharmaceuticals

📋 Description

• Manage end-to-end licensing and credentialing for new pharmacy locations, including state board of pharmacy licenses, DEA registration, NPI setup, and third-party payer enrollment. • Coordinate with clients, pharmacy staff, and internal stakeholders to collect and submit required documentation and applications accurately and on time. • Monitor progress of applications and approvals; follow up with agencies or payers to ensure timely completion. • Maintain detailed records and tracking systems for licensing and credentialing milestones and statuses. • Ensure compliance with federal, state, and local regulations related to pharmacy licensure and credentialing. • Serve as subject matter expert on licensing and payer enrollment processes for implementation projects. • Work closely with project managers to align credentialing timelines with implementation plans and go-live dates. • Develop and maintain standard operating procedures and tools for licensing and credentialing workflows. • Identify and escalate delays or risks impacting project timelines or regulatory compliance; support renewals and recredentialing post-implementation. • Forecast regulatory changes and adjust internal procedures proactively; develop dashboards or reporting tools for VP visibility. • Lead cross-functional meetings to resolve credentialing challenges across departments (IT, legal, operations).

🎯 Requirements

• Bachelor’s degree or equivalent work experience required. • Minimum 5 years of experience in pharmacy licensing, credentialing, or payer enrollment, preferably in a multi-site or healthcare management environment. • Thorough understanding of pharmacy regulatory requirements, state board processes, DEA registration, and payer enrollment procedures. • Experience working with or supporting 340B-covered entities (e.g., FQHCs, Ryan White grantees) is preferred. • Exceptional attention to detail, documentation, and organizational skills. • Ability to manage multiple concurrent licensing and credentialing processes with accuracy and efficiency. • Strong communication skills and experience working with external agencies and internal teams. • Problem-solving mindset and ability to navigate bureaucratic or delayed processes with persistence. • Proficient in Microsoft Office and credentialing management systems or tools.

🏖️ Benefits

• Primarily remote work • Occasional travel up to 10% to client sites, pharmacy locations, or licensing agencies • Flexible hours to accommodate regulatory deadlines or implementation schedules