- Plan, direct, and coordinate operational activities.
- Working across functions with peers in other groups to ensure collaboration for shared goals.
- Collaborates with other departments to develop Network curriculum, provider manuals, guidelines, and onboarding process & documentation.
- Partners with other departments in planning the training programs, curriculum, and activities.
- Collaborates with Field Operations to develop/enhance provider manuals, audit tools, guidelines, network communication, policies and procedures.
- Manages payer relationships, resolving billing and contract issues.
- Overall management of standardize documentation and workflows.
- Promote and perform continuous quality improvement monitoring to ensure internal and external engagement.
- Continuous mindset toward efficiency and process improvement – how to apply technology and processes to improve delivery and efficiency from both the Provider Group and internal perspective.
- Review policies, procedures and workflows, recommending revisions when necessary.
- Manages the design, implementation, written processes, and system used to monitor and evaluate credentialing delegated activities for all locations, adhering to corporate, federal and state regulatory/accreditation requirements and standards.
- Collaborates with the credentialing committee chair, develops and manages the credentialing committee.
- Assist in developing, updating, submission and completion of URAC, Departments of Insurance and NCQA compliance materials with documentation to demonstrate compliance with regulations/standards.
- Maintains team audits, competencies, and curriculum and test inventories.
- Working with senior management and other peers for strategy development, execution planning, and reporting.
- Communicating goal results and key performance indicators to direct reports.
- Coordinates company-wide process improvement programs and provides assistance to the quality improvement teams.
- Identify community standards, benchmarks, and best practices and assess company performance to community standards, benchmarks, and best practices to identify improvement opportunities.
- Periodically reviews the policies and procedures and makes recommendations for revisions. Monitors that staff comply with the established written policies and procedures.
- Develops, plans, schedules and conducts effective training for clinical and nonclinical staff.
- Implement network technology products, acting as product owner and train field operations.
- Drive continuous process and workflow performance improvements for network programs and products.
- Communicate with client, third party vendor, and partner relationships.
- Act as subject matter expert for technology across the network (EHRs, etc.), all current network programs, and performance reporting.
- Professionally represent the organization at all times; support the mission, goals and objectives; participate as a ‘team player”, constantly supporting other managers; set an example of high personal and professional conduct for employees and others.
- Performs other related duties as assigned.
- Bachelor’s degree or relevant professional experience
- Experience in project management, various EHR systems, product development, and physician relations.
- Preferred 5 years’ experience in healthcare.
- Knowledge of regulatory/accreditation requirements and standards (TDI, DOL/ERISA, HIPAA, NCQA, URAC, CMS)
- Credentialing experience.
- Knowledge of Power Point, Visio and Access.
- Value relationships; demonstrate professional respect and innovative mindset.
- Confident working with heath care professionals.
- Exercise judgment in order to problem solve when the answer is not readily apparent.
- Approach problem solving that involves systems thinking – understanding how the process works and how people are impacted by your decisions.
- Strong communication skills – understanding the need for being inclusive for effective results; communicate effectively with both day-to-day operational resources and executive management.
- Effectiveness in communication style (written and verbal), with proven ability to positively influence behavior toward a positive outcome.
- Understand sense of urgency, fast-paced and multi-tasking environment; strong organizational skills.
- Willingness and ability to attend after hour business meetings as needed.
- Proficient in computer and software programs (e.g. Microsoft Word, Excel).
- Self-motivated with the ability to work independently, as well as within a team environment.
- Proficient in data analysis, error discovery and resolution.
- Ability to adapt and quickly learn.
- Positive, service-oriented attitude. High level of integrity.
- Ability to coordinate multiple activities and work closely across all departments.
Healthcare trailblazer. Top 100 workplace. Fastest growing private company. We’ve been called them all. Here’s one that we’re most proud of: We’re a company that lives our purpose of helping communities thrive.
- Our communities deserve more than the increasingly broken healthcare system we have inherited.
- Innovation must connect the healthcare experience to move people the right way on their health journey.
- Healthcare is better when people are known.
- Those who have earned the most trust will produce the most meaningful change.
Every day, our team works to turn those beliefs into actions that are poised to change the way people think about and receive healthcare. Every day, we support people’s health journeys by authentically living our values: Purpose Driven, Relationships Matter, Serve Others First and Inspire Creativity.
Our inclusive and vibrant culture empowers team members strive, perform and have a lot of fun on the way.
If this connects with you, we’re looking for exceptional talent with a growth mindset … people who are ready to make an impact. We look forward to meeting you!
(if you already have a resume on Indeed)