Description/Responsibilities:
The Sr. Manager, Credentialing and Accreditation is responsible for overseeing credentialing and accreditation operations. This position manages a variety of staff and operations focused on credentialing, federal/state regulatory compliance, client audits and oversight of NCQA and URAC accreditations.
- Lead and manage credentialing activities in new and existing markets and ensure that operations meet NCQA credentialing standards and all federal/state specific regulatory requirements
- Manages the program delivery, oversight and maintenance for NCQA and URAC accreditations, including implementation of standards updates and changes
- Manages new client implementation including development and credentialing program workflow, pre-delegation audits, and regulatory requirements.
- Develop and implement strategies for credentialing operations across all product lines
- Participates in business analysis review for staffing models including quarterly and yearly review of metrics to support current and new business.
- Leads Quality Management Committee (QMC) to support evaluation of quality related objectives, and ensure compliance and regulatory requirements are met for policies and procedures
- Manages oversight of the Global Annual Evaluation, work plan, annual reports and annual evaluations
- Interact with current, new, and prospective Clients and/or internal Client teams to ensure credentialing delegation and client audits are understood, communicated, and implemented within the appropriate network teams
- Coordinate changes with Operations, Client Relations/Account Management, Marketing, and all other appropriate departments and design processes to improve inter-departmental communication
- Represent credentialing and accreditation on cross-functional teams and meetings, including new market rollout and product development
- Produce and distribute key indicator reports including credentialing turnaround times and re-credentialing
- Manage a team of colleagues and contractors
- Create, document, and implement or recommend process improvements
- Management and oversight of the credentialing vendor(s) and database(s)
- Assist in the development and implementation of database design enhancements
Qualifications:
- Current, active, unrestricted state license in the clinical arts (e.g., RN or BSN) is required.
- Bachelor’s degree in healthcare administration or related field is highly preferred.
- Experience in Credentialing operations and requirements, Utilization Management, and accreditation standards are preferred.
- Minimum of 5+ years of experience in a health care operations or managed care role required.
- 4+ years of supervisory experience required
- Operational experience within a health insurance environment
- Direct experience with accreditation/certification/audit activities required
- Direct experience with the supervision and management of personnel required
- Must exhibit excellent interpersonal skills and professionalism including strong verbal, telephonic and written communication skills
- Ability to work under pressure and have strong listening skills; build and maintain relationships with internal/external customers and present topics clearly and concisely
- Demonstrable strategic thinking abilities
- Analytical with problem-solving aptitude
- Excellent PC skills including proficiency with MS Office software
- Strong attention to detail and accuracy
The salary range for this opportunity is $96,600 to $135,300. Compensation depends on several factors: qualifications, skills, competencies, and experience.
Tivity Health offers a robust benefits package, which includes a competitive salary, company bonus potential, medical, dental, vision, 401k with match, generous paid time off, free gym membership to over 13,000 fitness locations in the US, and other great benefits.
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About Tivity Health® Inc.
Tivity Health, Inc. is a leading provider of healthy life-changing solutions, including SilverSneakers®, ForeverFit®, and WholeHealth Living®. We help adults improve their health and support them on life's journey by providing access to in-person and virtual physical activity, social and mental enrichment programs, as well as a full suite of physical medicine and integrative health services. Our suite of services support health plans, employers, health systems and providers nationwide as they seek to reduce costs and improve health outcomes. Learn more at TivityHealth.
Tivity Health is an equal employment opportunity employer and is committed to a proactive program of diversity development. Tivity Health will continue to recruit, hire, train, and promote into all job levels without regard to race, religion, gender, marital status, familial status, national origin, age, mental or physical disability, sexual orientation, gender identity, source of income, or veteran status.
