Credentialing Program Manager

🔥 9 minutes ago

🏈 Ohio – Remote

🏈 Ohio – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

📋 Administrative Assistant

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OhioHealth

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1891

⚕️ Healthcare Insurance

🧘 Wellness

📚 Education

Healthcare Insurance • Wellness • Education

OhioHealth is a not-for-profit healthcare system headquartered in Columbus, Ohio, dedicated to providing exceptional patient care and a wide range of medical services. With facilities spread across multiple locations, OhioHealth offers comprehensive healthcare services including cancer care, maternity, midlife clinics for women, virtual health appointments, and specialized care for transgender and LGBTQ patients. They also focus on patient education with health and wellness classes, support groups, and health quizzes. OhioHealth is committed to improving community health through various community relations and health initiatives. They provide resources such as price transparency, financial assistance, and patient rights information to enhance the healthcare experience for all patients.

📋 Description

• The CVO PM manages and coordinates the credentialing and recredentialing process for all applicants to the OhioHealth Medical Staff, Allied Practitioner Staff, the CIN, and/or the OhioHealthy Medical Plan. • The CVO PM will utilize three sets of credentialing policies and procedures managed by the CVO to support TJC accreditation for the OhioHealth hospitals and NCQA accreditation to support the CIN and OhioHealthy Medical Plan. • The CVO PM is accountable for ensuring all information is accurate and up to date prior to completing an application. • The CVO PM will collaborate with applicants and/or credentialing contacts to resolve discrepancies in application documents. • The CVO PM will collaborate with associates of other OhioHealth medical affairs teams, the CIN and/or OhioHealthy to address questions related to a providers credentialing application or status in the credentialing process. • The CVO PM will complete the credentialing assignment and ensure compliance with regulatory guidelines, including all applicable policies and procedures that govern the credentialing department. • The CVO PM will appropriately identify applications that require medical director review by following credentialing department policies specific to the CIN and OhioHealthy. • The CVO PM will prepare the Medical Director Review (MDR) packet and collaborate with CVO leadership when a review is needed. • The CVO PM will maintain confidentiality for all credentialing/re-credentialing/membership issues. • The CVO PM will participate in system-wide credentialing initiatives as identified (ex: process improvement projects). • The CVO PM will participate in KPI (key performance indicator) huddles as scheduled. • The CVO PM will participate in weekly gemba meetings including development of information to share along with presentation of topic as required by department gemba schedule. • The CVO PM will work individually and independently with minor supervision while meeting productivity expectations and maintaining high quality work.

🎯 Requirements

• Bachelor's Degree (Required) • Minimum of two years credentialing experience through a CVO-like department, or hospital medical staff/allied practitioner credentialing experience. • Knowledge of physician and allied practitioner credentialing processes. • Detailed understanding of TJC and NCQA credentialing requirements. • Credentialing database management (Cactus or similar credentialing database). • Familiarity with Microsoft products.

🏖️ Benefits

• Health insurance • Paid time off • Professional development opportunities