Provider Development Manager

Intermountain Health

3d • $44 - $68

About The Position

This position manages Provider Development functions and management of credentialing and contract administration of SelectHealth providers. Manages Provider Development processes, including: credentialing, contracting, compliance, programs, projects, initiatives, services, administration, and other key activities associated with supporting providers and networks. Manages key Provider Development functions, including caregivers, to ensure superior service is provided to all internal and external customers. This position is accountable for the management of Provider Development functions in support of the development, project management, reporting, credentialing and contract administration of providers in all markets. Essential Functions Leadership Demonstrates core leadership competencies including: Building a successful team, building strategic work relationships, coaching, communication, customer focus, facilitating change, financial acumen, planning and organizing, and selecting talent. Serves as the liaison between Provider Development, SelectHealth, Intermountain, and other entities on alignment and integration issues such as compliance, configuration, and directory accuracy. Credentialing and Contracting Administration Manages credentialing and contracting administration functions in all markets for all provider types, including delegated arrangements with CAQH and other entities. Coordinates contracting configuration activities with SelectHealth Legal, Operations, Service Excellence, credentialing, and other relevant departments to ensure contracts are accurate, implemented, and organized in the system. Ensures department credentialing and contracting administration functions are in alignment with NCQA, CMS, and other state specific requirements. In collaboration with Operations, ensures system credentialing and contract configuration is in alignment with system best practices. Manages all provider data files for provider networks to ensure systems and provider directories accurately reflect each commercial and government network on an ongoing basis. Department Compliance Maintains a working knowledge of all CMS, NCQA, state, and other requirements. Oversees department process, policy, and procedure to ensure ongoing compliance with federal, state, organization policy, and other regulatory agencies. Maintains comprehensive documentation of all compliance and accreditation requirements, including sources, ensuring ongoing audit readiness. Represents Provider Development in interactions with internal and external audit and compliance. Ensure comprehensive and accurate reporting of policies, procedures, and guidelines to internal and external auditing agencies. Manages process for network adequacy reporting to federal and state agencies. Maintains alignment with Quality Improvement, Internal Audit, Compliance, Legal, Operations, and other key SelectHealth departments. Oversees and performs delegated credentialing and contracting audits, including ongoing reporting and monitoring. Project Management and Coordination Oversees and manages Provider Development projects and initiatives in all markets. Maintains alignment with the SelectHealth Project Management Office, Operations, Sales, Product, Marketing, Government Programs, Actuarial, Reporting, Network Affordability, and other internal teams. Tracking and reporting of all key department projects. Facilitates data analysis and internal/external data modeling. Produces department data analysis, including facilitating data requests.

Requirements

• Four years of demonstrated progressive leadership experience in health insurance, operations, financial services, data analytics and reporting, healthcare administration, or other related industry.
• Demonstrated intermediate proficiency in word processing and spreadsheet programs.
• Demonstrated excellent written, verbal and interpersonal communication skills.
• Demonstrated excellent project, data analytics, time and workload management skills.
• Demonstrated experience in process improvement.
• An understanding of JCAHO, NCQA and State and Federal credentialing standards.

Nice To Haves

• Bachelor's degree in Business Administration, Communication or Healthcare or related field. Degree must be obtained through an accredited institution. Education is verified.
• Master's degree. Degree must be obtained through an accredited institution. Education is verified.
• Experience working in health care or health insurance business environment, particularly with provider credentialing, contracts and compliance.
• Demonstrated experience in relationship building
• Demonstrated analytical, reporting and technical abilities.

Responsibilities

• Leadership
• Credentialing and Contracting Administration
• Department Compliance
• Project Management and Coordination

Benefits

• We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.
• Learn more about our comprehensive benefits package here.
• Intermountain Health’s PEAK program supports caregivers in the pursuit of their education goals and career aspirations by providing up-front tuition coverage paid directly to the academic institution. The program offers 100+ learning options to choose from, including undergraduate studies, high school diplomas, and professional skills and certificates. Caregivers are eligible to participate in PEAK on day 1 of employment. Learn more.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 5,001-10,000 employees