Manager II, Credentialing at CareMore - PS

Company: CareMore
Location: Cerritos
Posted on: May 22, 2020

Job Description:

Your Talent. Our Vision. At CareMore, a proud member of the Anthem, Inc. family of companies specializing in providing senior Americans a complete and pro-active health care experience, it's a powerful combination. It's the foundation upon which we're creating greater care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve.

This position will be located in the Cerritos, CA office location.

The Manager II, Credentialing role is responsible for onboarding employed physicians and for managing 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.

Primary duties may include, but are not limited to:

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• Ensures all employed clinicians are on-boarded to ensure they have all appropriate licensure and documents required for credentialing.
• Ensures employed clinicians are privileged at the SNF and hospital facilities.
• 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.
  
  
  Requires a BA/BS degree in Business Administration, Health Science, medical records or related field; 3-5 years management and credentialing experience; or any combination of education and experience, which would provide an equivalent background.
  
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  • Managed care experience preferred.
  • MBA or MHA preferred.
    
    
    
    Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.
    
    
    
    
    
    
    

Keywords: CareMore, Cerritos , Manager II, Credentialing at CareMore - PS, Executive , Cerritos, California