Manager Delegated Credentialing
Manager Delegated Credentialing We're looking for colleagues who are ready to Think Big, Go Fast, Deliver Awe, and Win Together.
These core values embody our diverse and inclusive culture and help us live out our mission of getting people the care they need when they need it.
Over the last 30 years, our company has established itself as the market leader in managed care for the workers' compensation industry.
We are committed to making a positive impact in the lives of the injured workers we serve, and we have fun doing it.
Salary Range:
66100.
00 - 109100.
00 Salary This compensation range takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs.
The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled.
At One Call, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case.
A reasonable estimate of the current range is 66100.
00 - 109100.
00 Salary Benefits
Summary:
In return for your commitment to our company's mission, we offer a vast array of benefits to help support the whole you.
o Opportunities to work from home o Competitive wages with opportunities to earn annual merit increases o Paid development hours to use for professional and community development! o Generous paid time off, 8 company holidays, and 2 floating holidays per year o $1,000 Colleague Referral Program o Enterprise Recognition Program rewarding colleagues for their extraordinary work o Exclusive discounts on travel, activities, and merchandise via work discount program o Colleague Assistance Program that provides free counseling and financial services o Tuition Reimbursement Program including certifications o Quantum Health:
A healthcare navigation platform to help our colleagues make the best, most cost-effective healthcare decisions o Medical, dental, and vision insurance o Pre-Tax FSA and HSA health savings accounts o 401(k) matching o Company paid life insurance o Company paid short term and long-term disability o Referral program o Healthcare concierge o The One Call Foundation which aims to help colleagues during unexpected emergencies, from car accidents to natural disasters.
The Delegated Credentialing Manager is responsible for supporting multiple specialty areas of business operations surrounding delegated credentialing, and will execute the strategic business plan as well as lead the day-to-day functions and staff, encompassing delegated provider oversight for diverse programs/projects as assigned (including retention of providers who One Call has delegated credentialing as well as new providers for consideration of delegated credentialing).
This position will provide leadership, reporting, implementation support, and manage the monitoring of programs for services delivered through contracted, delegated entities (providers who One Call has sub-delegated contracts).
This position is instrumental in facilitating delegation program activities to ensure alignment with IEHP strategies, goals, and objectives.
GENERAL DUTIES &
Responsibilities:
DELEGATED CREDENTIALING:
40% Responsible for ensuring thorough preparation of documentation, reports, and any other information needed for regulatory and NCQA audits related to delegation oversight.
Confirm delegated provider credentialing audits performed by the delegated credentialing team for initial, annual, and interim assessments in accordance with One Call, Joint Commission, NCQA, CMS, state and federal requirements.
Ensure One Call's delegated credentialing process meets provider customer expectations using reports and trend analysis.
Ensure annual delegated credentialing audit timeliness and corrective action plans are met.
Manage credentialing rosters, reports, and delegated compliance of One Call Delegated Providers.
Communicate as a liaison for Delegated Providers and internal partners.
Manage and assist in the negotiation of delegated agreements.
Maintain working knowledge of regulatory credentialing requirements.
LEADERSHIP:
40% Lead the oversight of all delegated activities to ensure compliance with One Call policies, NCQA URAC, and Joint Commission credentialing requirements.
Implement, evaluate, and maintain a comprehensive delegation oversight program which supports all aspects of One Call credentialing sub-delegation criteria to ensure meeting ongoing business requirements.
Responsible for ensuring all providers maintain compliance and adhere to Corrective Action Plans (CAP).
Lead the development and maintenance of delegated related policies and procedures.
Supervises work of others, including planning, assigning, scheduling and reviewing work, ensuring quality standards.
Responsible for hiring, terminating, coaching/training and developing, reviewing performance, and administering corrective action for staff if necessary.
Plans organizational structure and job content.
Other duties as assigned.
COLLABORATION:
20% Collaborate effectively with key internal and external stakeholders, including clients, compliance/legal, account management/client success, and other matrix partners, as applicable.
Coordinate communication with delegates regarding One Call payer audits/internal audits.
Serve as a subject matter expert in interpreting compliance and regulatory requirements and ensuring overall areas are operational and in compliance with state, federal, and regulatory delegated functions.
Initiate implementation of new or changed regulatory and/or accreditation requirements to ensure the adequacy of controls of oversight activities.
Support presentation of delegated providers to the One Call provider quality and credentialing committee Ensure resolution of delegated credentialing escalations and issues with providers.
EDUCATIONAL, CERTIFICATION AND EXPERIENCE REQUIREMENTS:
A Bachelor's in Business, Healthcare Administration, or other related discipline is preferred, or equivalent combination of education and experience.
2
years Delegated Credentialing experience (in a Healthcare Organization or hospital credentialing setting) with at least 2 years Credentialing Management experience Certification by the National Association Medical Staff Services (NAMSS) as a Certified Professional in Medical Services Management (CPMSM), or Certified Provider Credentialing Specialist (CPCS) or commitment to achieve CPCS within twenty-four (24) months of start date.
GENERAL KNOWLEDGE, SKILLS & ABILITIES:
Strong analytical and problem-solving skills.
Ability to work effectively, both independently and within a team Ability to effectively coordinate and manage multiple projects of varying complexity and deadlines, while prioritizing work simultaneously and during high-pressure times Ability to develop and deliver presentations.
Effective data collection and organization with ability to critically review data and implement operational recommendations.
Strong organizational skills, detail oriented, and sound decision making skills required; exceptional follow-through abilities to track all outstanding tasks and coordinate with assigned owners to ensure tasks are completed timely.
Excellent communication, collaboration and interpersonal skills Experience in developing policy and procedure documentation.
Extensive knowledge of standard and delegated credentialing procedures and governing bodies standards.
Strong coaching, motivational and interpersonal skills are required with an emphasis on service, and team and individual improvement.
Ability to assume responsibility and exercise good judgment in making decisions within the scope of authority of the position.
Proficient in Microsoft Office applications.
PHYSICAL/EMOTIONAL DEMANDS & WORK ENVIRONMENT:
For roles located in office or home settings; this job is primarily sedentary and may involve repetitive motions; the employee is regularly required to sit, use hands and fingers, speak, and hear.
The employee is occasionally required to stand, walk, and lift objects (up to 10lbs weight; up to 4 ft.
height).
Specific vision abilities required by this job include ability to see things from a close distance and ability to adjust focus.
The work environment utilizes florescent lighting; noise level is moderate.
The emotional demand of the job may cause undue stress from, but not limited to, moderate/heavy workload.
Reasonable accommodations will be individually assessed and possibly made to enable individuals with disabilities to perform the essential functions of the position.
Please be advised this job description is subject to change at any time.
Recommended Skills Account Management Analytical Assessments Attention To Detail Auditing Business Requirements Estimated Salary: $20 to $28 per hour based on qualifications.
These core values embody our diverse and inclusive culture and help us live out our mission of getting people the care they need when they need it.
Over the last 30 years, our company has established itself as the market leader in managed care for the workers' compensation industry.
We are committed to making a positive impact in the lives of the injured workers we serve, and we have fun doing it.
Salary Range:
66100.
00 - 109100.
00 Salary This compensation range takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs.
The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled.
At One Call, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case.
A reasonable estimate of the current range is 66100.
00 - 109100.
00 Salary Benefits
Summary:
In return for your commitment to our company's mission, we offer a vast array of benefits to help support the whole you.
o Opportunities to work from home o Competitive wages with opportunities to earn annual merit increases o Paid development hours to use for professional and community development! o Generous paid time off, 8 company holidays, and 2 floating holidays per year o $1,000 Colleague Referral Program o Enterprise Recognition Program rewarding colleagues for their extraordinary work o Exclusive discounts on travel, activities, and merchandise via work discount program o Colleague Assistance Program that provides free counseling and financial services o Tuition Reimbursement Program including certifications o Quantum Health:
A healthcare navigation platform to help our colleagues make the best, most cost-effective healthcare decisions o Medical, dental, and vision insurance o Pre-Tax FSA and HSA health savings accounts o 401(k) matching o Company paid life insurance o Company paid short term and long-term disability o Referral program o Healthcare concierge o The One Call Foundation which aims to help colleagues during unexpected emergencies, from car accidents to natural disasters.
The Delegated Credentialing Manager is responsible for supporting multiple specialty areas of business operations surrounding delegated credentialing, and will execute the strategic business plan as well as lead the day-to-day functions and staff, encompassing delegated provider oversight for diverse programs/projects as assigned (including retention of providers who One Call has delegated credentialing as well as new providers for consideration of delegated credentialing).
This position will provide leadership, reporting, implementation support, and manage the monitoring of programs for services delivered through contracted, delegated entities (providers who One Call has sub-delegated contracts).
This position is instrumental in facilitating delegation program activities to ensure alignment with IEHP strategies, goals, and objectives.
GENERAL DUTIES &
Responsibilities:
DELEGATED CREDENTIALING:
40% Responsible for ensuring thorough preparation of documentation, reports, and any other information needed for regulatory and NCQA audits related to delegation oversight.
Confirm delegated provider credentialing audits performed by the delegated credentialing team for initial, annual, and interim assessments in accordance with One Call, Joint Commission, NCQA, CMS, state and federal requirements.
Ensure One Call's delegated credentialing process meets provider customer expectations using reports and trend analysis.
Ensure annual delegated credentialing audit timeliness and corrective action plans are met.
Manage credentialing rosters, reports, and delegated compliance of One Call Delegated Providers.
Communicate as a liaison for Delegated Providers and internal partners.
Manage and assist in the negotiation of delegated agreements.
Maintain working knowledge of regulatory credentialing requirements.
LEADERSHIP:
40% Lead the oversight of all delegated activities to ensure compliance with One Call policies, NCQA URAC, and Joint Commission credentialing requirements.
Implement, evaluate, and maintain a comprehensive delegation oversight program which supports all aspects of One Call credentialing sub-delegation criteria to ensure meeting ongoing business requirements.
Responsible for ensuring all providers maintain compliance and adhere to Corrective Action Plans (CAP).
Lead the development and maintenance of delegated related policies and procedures.
Supervises work of others, including planning, assigning, scheduling and reviewing work, ensuring quality standards.
Responsible for hiring, terminating, coaching/training and developing, reviewing performance, and administering corrective action for staff if necessary.
Plans organizational structure and job content.
Other duties as assigned.
COLLABORATION:
20% Collaborate effectively with key internal and external stakeholders, including clients, compliance/legal, account management/client success, and other matrix partners, as applicable.
Coordinate communication with delegates regarding One Call payer audits/internal audits.
Serve as a subject matter expert in interpreting compliance and regulatory requirements and ensuring overall areas are operational and in compliance with state, federal, and regulatory delegated functions.
Initiate implementation of new or changed regulatory and/or accreditation requirements to ensure the adequacy of controls of oversight activities.
Support presentation of delegated providers to the One Call provider quality and credentialing committee Ensure resolution of delegated credentialing escalations and issues with providers.
EDUCATIONAL, CERTIFICATION AND EXPERIENCE REQUIREMENTS:
A Bachelor's in Business, Healthcare Administration, or other related discipline is preferred, or equivalent combination of education and experience.
2
years Delegated Credentialing experience (in a Healthcare Organization or hospital credentialing setting) with at least 2 years Credentialing Management experience Certification by the National Association Medical Staff Services (NAMSS) as a Certified Professional in Medical Services Management (CPMSM), or Certified Provider Credentialing Specialist (CPCS) or commitment to achieve CPCS within twenty-four (24) months of start date.
GENERAL KNOWLEDGE, SKILLS & ABILITIES:
Strong analytical and problem-solving skills.
Ability to work effectively, both independently and within a team Ability to effectively coordinate and manage multiple projects of varying complexity and deadlines, while prioritizing work simultaneously and during high-pressure times Ability to develop and deliver presentations.
Effective data collection and organization with ability to critically review data and implement operational recommendations.
Strong organizational skills, detail oriented, and sound decision making skills required; exceptional follow-through abilities to track all outstanding tasks and coordinate with assigned owners to ensure tasks are completed timely.
Excellent communication, collaboration and interpersonal skills Experience in developing policy and procedure documentation.
Extensive knowledge of standard and delegated credentialing procedures and governing bodies standards.
Strong coaching, motivational and interpersonal skills are required with an emphasis on service, and team and individual improvement.
Ability to assume responsibility and exercise good judgment in making decisions within the scope of authority of the position.
Proficient in Microsoft Office applications.
PHYSICAL/EMOTIONAL DEMANDS & WORK ENVIRONMENT:
For roles located in office or home settings; this job is primarily sedentary and may involve repetitive motions; the employee is regularly required to sit, use hands and fingers, speak, and hear.
The employee is occasionally required to stand, walk, and lift objects (up to 10lbs weight; up to 4 ft.
height).
Specific vision abilities required by this job include ability to see things from a close distance and ability to adjust focus.
The work environment utilizes florescent lighting; noise level is moderate.
The emotional demand of the job may cause undue stress from, but not limited to, moderate/heavy workload.
Reasonable accommodations will be individually assessed and possibly made to enable individuals with disabilities to perform the essential functions of the position.
Please be advised this job description is subject to change at any time.
Recommended Skills Account Management Analytical Assessments Attention To Detail Auditing Business Requirements Estimated Salary: $20 to $28 per hour based on qualifications.
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