Senior Manager, Licensing and Credentialing

Emploi pas sur LinkedIn

🕒 il y a 1 mois

🇺🇸 États-Unis – Télétravail

💵 $100 000 - $113 000 / an

⏰ Temps Plein

🟠 Senior

👔 Manager

👻 Score fantôme 3%

Ce que ça veut dire : la probabilité que cette offre reste ouverte sans recrutement actif.Comment le lire : 60 % ou plus, on pense que c'est une offre fantôme. Un score plus bas est moins inquiétant.Comment on la calcule : ancienneté, republications, postes ouverts vs taille de l'équipe, rapidité de clôture, et si le salaire est indiqué.À noter : une estimation à partir de données publiques, pas un jugement sur l'entreprise. De vraies offres peuvent avoir un score élevé, alors prenez-le comme un indice, pas comme un fait.

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Author Health

Site WebLinkedInTous les Emplois

51 - 200 employés

Fondée en 2023

💼 Conseil

🛡️ Assurance

🏥 Santé

💰 €115 000 000 Series A - Author Health en 2023-06

Consulting • Insurance • Healthcare

Author Health est un fournisseur coordonné de soins de santé comportementale qui offre des services de gestion des soins et de santé mentale en équipe pour les personnes ayant des besoins complexes en santé mentale, notamment la démence, la dépression et l'anxiété sévères, le trouble bipolaire, le SSPT, la schizophrénie et les troubles liés à la consommation de substances. Ils combinent la psychiatrie virtuelle, des infirmiers praticiens, des travailleurs sociaux cliniciens agréés et des gestionnaires de soins en personne pour intégrer les soins cliniques aux services communautaires et aux partenaires d'assurance (y compris Medicare et les plans Medicare Advantage), en se concentrant sur les soins holistiques, le partage d'informations conforme à la HIPAA et l'amélioration de la qualité de vie.

Description

• 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

🎯 Exigences

• 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

🏖️ Avantages

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