Steward Health Care Network (SHCN) takes pride in its community-based care model, which drives value-added tools and services to our communities, patients, physicians, and hospitals across the continuum of care. In addition, Steward Health Care Network promotes care coordination and collaboration within the network in order to provide high-quality, efficient care to patients. With Steward in the community, all residents can be sure that there is a world-class doctor close to where they live.
The network is also responsible for the implementation and execution of our managed care contracts, medical management services, quality improvement programs, data analysis, and information services.
Position Purpose: Reporting to the National Director, Credentialing & Provider Enrollment, the Credentialing Supervisor coordinates the accurate and efficient Credentialing and Recredentialing of SHCN providers in alignment with State, Federal, and NCQA standards.
- Responsible for managing, organizing, and coordinating all aspects of the Credentialing and Recredentialing activities for practitioners and organizational providers in accordance to credentialing standards and guidelines. Responsible for the management of the Credentialing Department: recruitment, training, performance evaluations and disciplinary actions
- Review and manage provider credentialing processes to ensure that policies/workflows (desktop manuals, policy updates, etc.) are followed in compliance with State, Federal, and NCQA guidelines as well as health plan directives. Identifies opportunities for improvements in the process and develops strategies to implement appropriate changes/enhancements; develop partnerships with relevant internal and external staff; independently troubleshooting issues as they arise
- Conduct monthly audits of the Credentialing Coordinator’s files to ensure alignment with NCQA standards
- Accountability for delegated oversight, including performing pre-delegation and annual audits to ensure compliance with the delegated credentialing agreements and regulatory standards. Responsible for coordination and management of the health plan Credentialing Committee(s). Responsible for leading the Credentialing Committee(s) meeting(s)
- Coordinate with the National Director, Credentialing & Provider Enrollment to pursue incremental delegated credentialing agreements (both the provider and hospital delegated credentialing, along with other potential opportunities) with the payers
- Respond to general inquiries and assist in resolution of administrative and operational issues. Manage staff data entry to maintain database/computerized credentialing system. Prepare and maintain various reports, data, and summaries of credentialing activities. Responsible for administrating and maintaining quality control processes of all Credentialing activities
- Collaborate with the SHCN Provider Enrollment Supervisor, SHCN National Director and SMG Provider Enrollment, Credentialing and Onboarding teams to ensure workflows and deadlines are met as a team
- Maintain on-going participation in cross-training activities, ensuring appropriate staff training and coverage of incoming volume. Actively engage in addressing special projects as they arise, conducting preliminary research and follow-up, and tracking/monitoring to facilitate on-going reporting of project status. Provides valid feedback to the Credentialing Director on departmental issues and progress
- Perform other functions as assigned
Education / Experience / Other Requirements
- Bachelor’s degree in relevant field (or equivalent combination of education and experience)
Years of Experience:
- Five to seven years of relevant experience in healthcare related environment, preferably with supervisory experience in a credentialing/recredentialing environment with knowledge of several sets of national accreditation or regulatory criteria
- Microsoft Office software (Word, Access, Excel, PowerPoint), and experience with Credentialing systems
- Previous Managed Care and/or Medicaid experience strongly preferred
- Ability to work independently with minimal supervision as the direct manager of this role is located offsite
- Ability to manage people and work in teams
- Ability to analyze and evaluate data and other provider related problems in order to develop alternative solutions for a positive outcome
- Ability to multi-task and prioritize workload, manage multiple priorities, and pay meticulous attention to detail
- Thorough understanding of managed care principles and physician practice operations, with an understanding of health plan provider enrollment and credentialing preferred
- Excellent organizational skills, proven project management expertise; Strong verbal and written communication skills
- Outstanding interpersonal skills, able to quickly establish a trusting rapport with individuals at all levels
- Requisite poise, judgment, and trustworthiness to represent SHCN to internal and external groups
- Maintains information in a confidential manner according to policy
This position is subject to the COVID-19 Vaccination Policy for Steward Health Care Workforce. Employees in this position will be required to provide adequate proof of vaccination for COVID-19 by an FDA-approved vaccine prior to starting work. Steward will consider requests for exemptions from this vaccine requirement on the basis of medical condition or sincerely held religious belief in accordance with applicable Federal laws.
Steward Health Care is an Equal Employment Opportunity (EEO) employer. Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic.
Steward Health Care Network is taking additional, necessary preparations to ensure patients can receive compassionate care in a safe, carefully managed environment – with confidence and without fear.
Our Safe and Ready program consists of a rigorous [three-point] standard ensuring patient safety, confidence and convenience:
- Any COVID-19 related care takes place in designated areas away from other patients and their families.
- A stringent cleaning policy has been implemented throughout our facilities.
- A strictly controlled visitor and masking policy is required for patient and colleague safety.
You can rest assured that we have made the necessary preparations to provide care in a safe, controlled and professional way.