Manager II, Credentialing - BioPlus Specialty Pharmacy
About The Position
The Manager II, Credentialing - BioPlus Specialty Pharmacy develops, implements and controls the credentialing process for all in-house professional provider consultants and all contracted providers within the region. Provides guidance regarding policies, procedures and regulatory requirements. This role is a hybrid position, requiring associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. Alternate locations may be considered if candidates reside within a commuting distance from an office. BioPlus Specialty Pharmacy is a proud member of the Elevance Health family of companies, offering consumers and providers an unparalleled level of service that’s easy and focused on whole health. Through distinct clinical expertise, digital capabilities, and broad access to specialty medications, they deliver an elevated experience, affordability, and personalized support.
Requirements
- Requires a BA/BS degree in Business Administration, Health Science, medical records or related field.
- A minimum of 3 years management and credentialing experience.
- Any combination of education and experience, which would provide an equivalent background.
Nice To Haves
- Managed care experience strongly preferred.
- MBA or MHA degree strongly preferred.
- People leadership experience strongly preferred.
Responsibilities
- Ensures that all legal, licensure and accreditation standards are met.
- Reviews the approval and termination of professional provider contracts as they relate to the credentialing process.
- Ensures the accurate and timely information for the purposes of re-credentialing, data analysis and directory generation as well as recommending changes to the credentialing criteria and processes.
- Monitors all governmental and private agency initiatives in the credentialing area.
- Ensures all credentialing and re-credentialing policies and processes are in compliance with NCQA and all applicable state regulations.
- Assures credentialing activities are integrated within the appropriate QI committees and departments.
- Hires, trains, coaches, counsels and evaluates performance of direct reports.
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical
- dental
- vision
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
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What This Job Offers
Job Type
Full-time
Career Level
Manager
