Credentialing Program Manager - Central Verification Office
About The Position
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.
Requirements
- Bachelor's Degree
- 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.
Nice To Haves
- Outstanding communication skills, both written and oral
- Strong organizational skills and attention to detail
- Open to feedback
- 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
- 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.
- Utilizes 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.
- Accountable for ensuring all information is accurate and up to date prior to completing an application.
- Collaborates with applicants and/or credentialing contacts to resolve discrepancies in application documents.
- Collaborates 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.
- Completes the credentialing assignment and ensures compliance with regulatory guidelines, including all applicable policies and procedures that govern the credentialing department.
- Appropriately identifies applications that require medical director review by following credentialing department policies specific to the CIN and OhioHealthy.
- Prepares the Medical Director Review (MDR) packet and collaborates with CVO leadership when a review is needed.
- Maintains confidentiality for all credentialing/re-credentialing/membership issues.
- Participates in system-wide credentialing initiatives as identified (ex: process improvement projects).
- Participates in KPI (key performance indicator) huddles as scheduled.
- Participates in weekly gemba meetings including development of information to share along with presentation of topic as required by department gemba schedule.
- Works individually and independently with minor supervision while meeting productivity expectations and maintaining high quality work.
- Focuses on safety, quality and efficiency in performing job duties as a High Reliability Organization (HRO).
Benefits
- Great Place to Work CertifiedTM organization
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
