University of Utah Health HP Manager, Credentialing in murray, Utah

Overview

As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, diversity, integrity, quality and trust that are integral to our mission. EO/AA

Under the direction of the Health Plans Provider Network Director, the Health Plans Credentialing Manager is responsible for maintaining compliance with all Client, Federal, State regulations, NCQA standards, and managed care criterion related to credentialing and re-credentialing of practitioners, organizational providers and provider delegation. The scope of this role is to support a portfolio of health plans, product lines, and other potential projects and product types.

Responsibilities

Job Specific Responsibilities and Accountabilities

  • Performs to required standards for job specific responsibilities and technical competencies.

Talent Management

  • Hiring, training, developing, and communicating with staff.

Financial Management

  • Responsible for developing, monitoring and achieving budget goals.

  • Manages labor and non-labor expenses to budget or flex budget.

  • Manages revenue to budget to maximize potential revenue.

EPE/Service

  • Responsible for patient satisfaction scores within assigned area(s).

  • Responsible for upholding PROMISE standards of direct reports and team members.

Quality

  • Responsible to achieve quality goals for assigned area(s).

  • Manages and promotes continuous process improvements in assigned area(s).

Performance Management

  • Responsible to provide staff feedback on performance, including on-time appraisals and coaching.

  • Responsible to deal with conflicts in a proactive manner and to reach resolution in a timely manner.

Building Relationships

  • Forms positive relationships with staff, peers, and senior leadership to support the mission, vision, values, and performance standards of the organization.

  • Actively engages staff with updates and news as well as involving staff in decisions and work teams. Provides feedback and recognition when appropriate.

Knowledge / Skills / Abilities

  • Ability to lead the development of and manage credentialing business plans, delegation oversight, strategies and goals.

  • Ability to assist in managing and improving credentialing operations to achieve or exceed performance standards and budget.

  • Ability to maintain awareness and address all credentialing issues for assigned clients with short and long term solutions.

  • Effectively represents the organization in all internal/external interactions.

  • Ability to collaborate with all levels of management across cross functional departments to achieve departmental goals and objectives.

  • Knowledge of appropriate local, state, and federal regulations.

  • Ability to manage all internal and external credentialing audits (NCQA, Medicaid, Medicare, HEDIS®, etc.

  • Ability to establish credibility and develop collaborative relationships with hospitals, physicians, and ancillary providers.

  • Ability to analyze and maintain performance metrics related to credentialed practitioner's performance. Facilitate Credentials Committee meeting, and create necessary reports to keep the Credentialing Committee up to date with required related to the provider network. Provide performance data to the Credentialing Committee Chair

  • Ability to supervise, train and mentor staff and communicate effectively with staff, management, executives, and physicians.

  • Ability to monitor the quantity and quality of the staff to ensure compliance with productivity and quality measures. Identifies barriers to meeting goals and implements activities to alleviate barriers.

  • Demonstrated strong organization, time management and project management skills and multi-tasking abilities.

  • Demonstrated advanced analytical skills and problem solving skills with the ability to formulate and communicate recommendations for improvement.

  • Ability to coordinate budget expenditures through effective planning, monitoring and forecasting.

  • Knowledge of the Utah and intermountain region health community, including public and private entities and their role in the provision of health care is preferred.

  • Ability to work effectively, independently, and as part of a team.

  • Demonstrated computer skills (including Excel, Word).

Qualifications

Qualifications

Required

  • A Bachelor’s degree or equivalent related healthcare experience.

  • A minimum of 5 years related healthcare experience in provider credentialing, provider or payer relations, provider/vendor contracting and/or delegation oversight.

  • Knowledge of NCQA and CMS credentialing standards, which includes state and federal regulations

Qualifications (Preferred)

Preferred

  • Master’s degree in Health Care Administration, Business Administration, or related area.

  • Previous management experience.

  • 2 - 4 years delegated credentialing and/or managed care credentialing experience preferred.

  • Certified Provider Credentialing Specialist (CPCS) Certified Provider Credentialing Specialist

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation.

  • This is a sedentary position in an office setting that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.

Physical Requirements

Listening, Sitting, Speaking, Standing, Walking

Requisition Number 28915

Reg/Temp Regular

Employment Type Full-Time

Shift Day

Work Schedule Days

Location Name University of Utah Health Plans

Patient Care? No

City Murray

State UT

Department UIP CST 01H UUHP PROVIDER SRVC

Category Insurance / Health Plans

The University of Utah Health Care is an Affirmative Action/Equal Opportunity employer. Upon request, reasonable accommodations in the application process will be provided to individuals with disabilities. The University of Utah Health Care is committed to diversity in its workforce. Women and minorities are encouraged to apply.