Credentialing Program Manager

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Job Description Summary:

The Central Verifications Office Credentialing Program Manager (CVO PM) reports to the Director of CVO & Network Operations. The CVO PM ensures that practitioners (physicians, podiatrists, dentists, psychologists and allied practitioners) are properly credentialed in order to comply with applicable legal, professional and regulatory requirements. The CVO PM manages and coordinates the credentialing and recredentialing process for all applicants to the OhioHealth Medical Staff, Allied Practitioner Staff, the Clinically Integrated Network (CIN), and/or the OhioHealthy Medical Plan. The CVO PM is responsible for managing all aspects of the credentialing process that include an extensive knowledge of both The Joint Commission (TJC) and National Committee for Quality Assurance (NCQA) policies and procedures.

Responsibilities And Duties:

90%
The CVO PM manages and coordinates the credentialing and recredentialing process for all applicants to the OhioHealth Medical Staff, Allied Practitioner Staff, the CIN, and/or the OhioHealthy Medical Plan.  The CVO PM will utilize three sets of credentialing policies and procedures managed by the CVO to support TJC accreditation for the OhioHealth hospitals and NCQA accreditation to support the CIN and OhioHealthy Medical Plan. 

The CVO PM is accountable for ensuring all information is accurate and up to date prior to completing an application.  The CVO PM will collaborate with applicants and/or credentialing contacts to resolve discrepancies in application documents. The CVO PM will collaborate with associates of other OhioHealth medical affairs teams, the CIN and/or OhioHealthy to address questions related to a providers credentialing application or status in the credentialing process. 

The CVO PM will complete the credentialing assignment and ensure compliance with regulatory guidelines, including all applicable policies and procedures that govern the credentialing department.  The CVO PM will appropriately identify applications that require medical director review by following credentialing department policies specific to the CIN and OhioHealthy.  The CVO PM will prepare the Medical Director Review (MDR) packet and collaborate with CVO leadership when a review is needed.

The CVO PM will maintain confidentiality for all credentialing/re-credentialing/membership issues.  This individual will have access to confidential provider information and a high degree of discretion and sensitivity in communications is necessary.  Confidentiality must be maintained.

10%
The CVO PM will participate in system-wide credentialing initiatives as identified (ex: process improvement projects)
The CVO PM will participate in KPI (key performance indicator) huddles as scheduled.
The CVO PM will participate in weekly gemba meetings including development of information to share along with presentation of topic as required by department gemba schedule.
The CVO PM will work individually and independently with minor supervision while meeting productivity expectations and maintaining high quality work.  

Minimum Qualifications:

Bachelor's Degree

Additional Job Description:

• Years of experience: 2

SPECIALIZED KNOWLEDGE

• Minimum of two years credentialing experience through a CVO-like department, or hospital medical staff/allied practitioner credentialing experience.
•   Knowledge of physician and allied practitioner credentialing processes.
• Detailed understanding of TJC and NCQA credentialing requirements. 
• Credentialing database management (Cactus or similar credentialing database).  Familiarity with Microsoft products.

DESIRED ATTRIBUTES

Outstanding communication skills, both written and oral; strong organizational skills and attention to detail.  Open to feedback.  Is an autonomous worker (work from home environment).  Ability to work in a fast-paced environment and adaptable to change.  Provides excellent customer service and exhibits strong professionalism. 

RESPONSIBILITIES AND DUTIES

90%

The CVO PM manages and coordinates the credentialing and recredentialing process for all applicants to the OhioHealth Medical Staff, Allied Practitioner Staff, the CIN, and/or the OhioHealthy Medical Plan.  The CVO PM will utilize three sets of credentialing policies and procedures managed by the CVO to support TJC accreditation for the OhioHealth hospitals and NCQA accreditation to support the CIN and OhioHealthy Medical Plan. 

The CVO PM is accountable for ensuring all information is accurate and up to date prior to completing an application.  The CVO PM will collaborate with applicants and/or credentialing contacts to resolve discrepancies in application documents. The CVO PM will collaborate with associates of other OhioHealth medical affairs teams, the CIN and/or OhioHealthy to address questions related to a providers credentialing application or status in the credentialing process. 

The CVO PM will complete the credentialing assignment and ensure compliance with regulatory guidelines, including all applicable policies and procedures that govern the credentialing department.  The CVO PM will appropriately identify applications that require medical director review by following credentialing department policies specific to the CIN and OhioHealthy.  The CVO PM will prepare the Medical Director Review (MDR) packet and collaborate with CVO leadership when a review is needed.

The CVO PM will maintain confidentiality for all credentialing/re-credentialing/membership issues.  This individual will have access to confidential provider information and a high degree of discretion and sensitivity in communications is necessary.  Confidentiality must be maintained.

10%

The CVO PM will participate in system-wide credentialing initiatives as identified (ex: process improvement projects)

The CVO PM will participate in KPI (key performance indicator) huddles as scheduled.

The CVO PM will participate in weekly gemba meetings including development of information to share along with presentation of topic as required by department gemba schedule.

The CVO PM will work individually and independently with minor supervision while meeting productivity expectations and maintaining high quality work.  

Work Shift:

Day

Scheduled Weekly Hours :

40

Department

Credentialing

Join us!
... if your passion is to work in a caring environment
... if you believe that learning is a life-long process
... if you strive for excellence and want to be among the best in the healthcare industry

Equal Employment Opportunity

OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment 

Remote Work Disclaimer:

Positions marked as remote are only eligible for work from Ohio.