Description/ResponsibilitiesThe Sr. Manager, Credentialing and Accreditation is responsible for overseeing credentialing and accreditation operations. This position manages a variety of staff and operations focused on credentialing, federal/state regulatory compliance, client audits and oversight of NCQA and URAC accreditations.
- Lead and manage credentialing activities in new and existing markets and ensure that operations meet NCQA credentialing standards and all federal/state specific regulatory requirements
- Manages the program delivery, oversight and maintenance for NCQA and URAC accreditations, including implementation of standards updates and changes
- Manages new client implementation including development and credentialing program workflow, pre-delegation audits, and regulatory requirements.
- Develop and implement strategies for credentialing operations across all product lines
- Participates in business analysis review for staffing models including quarterly and yearly review of metrics to support current and new business.
- Leads Quality Management Committee (QMC) to support evaluation of quality related objectives, and ensure compliance and regulatory requirements are met for policies and procedures
- Manages oversight of the Global Annual Evaluation, work plan, annual reports and annual evaluations
- Interact with current, new, and prospective Clients and/or internal Client teams to ensure credentialing delegation and client audits are understood, communicated, and implemented within the appropriate network teams
- Coordinate changes with Operations, Client Relations/Account Management, Marketing, and all other appropriate departments and design processes to improve inter-departmental communication
- Represent credentialing and accreditation on cross-functional teams and meetings, including new market rollout and product development
- Produce and distribute key indicator reports including credentialing turnaround times and re-credentialing
- Manage a team of colleagues and contractors
- Create, document, and implement or recommend process improvements
- Management and oversight of the credentialing vendor(s) and database(s)
- Assist in the development and implementation of database design enhancements
Qualifications- Current, active, unrestricted state license in the clinical arts (e.g., RN or BSN) is required.
- Bachelor's degree in healthcare administration or related field is highly preferred.
- Experience in Credentialing operations and requirements, Utilization Management, and accreditation standards are preferred.
- Minimum of 5+ years of experience in a health care operations or managed care role required.
- 4+ years of supervisory experience required
- Operational experience within a health insurance environment
- Direct experience with accreditation/certification/audit activities required
- Direct experience with the supervision and management of personnel required
- Must exhibit excellent interpersonal skills and professionalism including strong verbal, telephonic and written communication skills
- Ability to work under pressure and have strong listening skills; build and maintain relationships with internal/external customers and present topics clearly and concisely
- Demonstrable strategic thinking abilities
- Analytical with problem-solving aptitude
- Excellent PC skills including proficiency with MS Office software
- Strong attention to detail and accuracy
The salary range for this opportunity is $96,600 to $135,300. Compensation depends on several factors: qualifications, skills, competencies, and experience.
Tivity Health offers a robust benefits package, which includes a competitive salary, company bonus potential, medical, dental, vision, 401k with match, generous paid time off, free gym membership to over 13,000 fitness locations in the US, and other great benefits.
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