Senior Manager of Credentialing and Managed Care

    • Job Tracking ID: 512635-581767
    • Job Location: Memphis, TN
    • Job Level: Management
    • Level of Education: BA/BS
    • Job Type: Full-Time/Regular
    • Date Updated: September 19, 2017
    • Years of Experience: 2 - 5 Years
    • Starting Date: October 16, 2017
    • PCN: RSS0320
    • Position: Senior Manager of Credentialing and Managed Care
    • Date: 6/30/17
    • FLSA Status: Exempt
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Job Description:

This position manages the provider credentialing, payer enrollment, and hospital privileging functions and manages the organization managed care contracts. The role supports the credentialing process for existing and new providers, including delegated enrollment, and ensures compliance with all relevant standards and regulations including, but not limited to, NCQA, Medicare, and Tricare. Enrolls billable providers in applicable 3rd party payer plans within appropriate timeframes and manages the organization managed care contracts. Responsible for fostering effective relationships with operational leadership, physicians, payers and hospital partners. Ensures the effective operation of the Credentialing Committee.

 

KEY RESULT AREAS (KRAs)

  • Credentialing process effectiveness

  • Payer enrollment effectiveness

  • Hospital privileging effectiveness

  • Managed care contract effectiveness

  • Provider relations

  • Credentialing Committee support

  • Regulatory compliance

  • Employee development

  • Employee effectiveness

     

Experience and Skills:

  • Bachelor’s degree in business, healthcare related field, or minimum of 7 years of relevant payer contract support, credentialing and/or enrollment experience, or an equivalent combination of education and relevant work experience.
  • Managed care contract review and management experience strongly preferred

  • 3 years managerial experience strongly preferred

  • Strong detail orientation and high work quality standards

  • Knowledge of NCQA standards

  • Knowledge of Medicare/Medicaid/TennCare regulations, PPO, and HMO arrangements, third party payer protocols, and medical terminology

  • Strong organizational skills and detail-oriented with the ability to multi-task

  • High level critical thinking and problem-solving skills

  • Strong Excel and database management skills

  • Demonstrated high levels of initiative, innovation, and collaboration.

  • Desire for process improvement.

  • Analytical and goal oriented

  • Strong customer service orientation

  • Strong time management and priorities management skills

  • Excellent interpersonal, written and verbal communication skills

  • Position can expect to spend 25% of time in meetings


Appointments will be based on merit as it relates to position requirements without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, or veteran status. Successful candidates must submit documentation verifying employment eligibility and identity and successfully pass a drug test to be employed by University Clinical Health. External candidates apply online at http://universityclinicalhealth.com/careers. University Clinical Health is committed to ensuring equal employment opportunity, including providing reasonable accommodations to individuals with a disability. Applicants with a physical or mental disability who require a reasonable accommodation for any part of the application or hiring process may contact the Human Resource Department at 901-866-8100 or fax 901-302-2008.