Job Description

Location: Steward Health Care Network
Posted Date: 12/6/2022

Position Purpose:

This position interfaces and partners with the Quality Management Leadership team and cross functional business partners to provide expertise in the area of credentialing/re-credentialing of practitioners in alignment with NCQA standards. The position acts as a liaison between SHCN and our Providers and manages the Credentialing and Provider Enrollment team.

Key Responsibilities:

  • Oversee all aspects of the credentialing/re-credentialing of practitioners in alignment with NCQA standards. Assure compliance with CMS, AHCCCS and other regulatory entities. Also responsible for pre-delegated and annual audits of all credentialing delegated entities. Manage all activities and ensure quality related to credentialing operations and payer enrollment, and provide oversight to ensure the continued growth and development of the organization.
  • Responsible for annual quality improvement reports. Prepare credentials files for presentation to committees, payers, and clients within established deadlines or appoint designee. Support Credentialing and Quality meetings on an ongoing basis; coordinating meeting times, schedules, developing agenda and presenting necessary documents for review with the respective committees.
  • Train and mentor members of the team. Act as a liaison between SHCN and our Providers. Additionally, educate and effectively work with the credentialing team and clinicians to facilitate a seamless credentialing experience.
  • Ensure compliance with regulations and contractual obligations. Effectively use financial information for strategic and operational decision making, participate in the preparation of annual budgets, and monitor performance to budget and meet agreed upon metrics
  • Leads the charge in focus and implementation of the organization's culture and strategic plan in a way that aligns to the mission, vision and values of the organization.

Education:

  • Bachelor’s degree preferred
  • Master’s degree strongly preferred

Years of Experience:

  • Six (6) years in health care quality focused roles
  • Significant experience in credentialing/ re-credentialing and provider enrollments. Clear advancement in responsibilities and outputs is preferred.
  • Excellent verbal and written communication skills

Specialized Knowledge:

  • Strong analytic skills and the ability to translate complicated data into useable information, including analysis of practice variation.
  • Demonstrated organizational and project management skills to manage complex projects through effective planning, tracking, and resource allocation to meet business objectives and timelines.
  • Strong leadership and management skills. Knowledge of methods used for improving employee performance/motivation.
  • Ability to generate creative solutions, identify the best course of action and rapidly resolve complex issues/problems
  • Skill in resolving employee/customer conflicts and complaints in a mutually satisfactory way
  • Ability to communicate clearly with employees at all organizational levels, and across differing cultural backgrounds

Application Instructions

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