Credentialing Program Manager

This is a fully remote position, open to applicants in Ohio.

📋 Description

• The CVO PM oversees and orchestrates the credentialing and recredentialing processes for all candidates applying to the OhioHealth Medical Staff, Allied Practitioner Staff, the CIN, and/or the OhioHealthy Medical Plan.

• The CVO PM will apply three sets of credentialing policies and procedures managed by the CVO to facilitate TJC accreditation for OhioHealth hospitals and NCQA accreditation to support the CIN and OhioHealthy Medical Plan.

• The CVO PM is responsible for ensuring that all information is correct and current before finalizing an application.

• The CVO PM will collaborate with applicants and/or credentialing representatives to address any discrepancies in application documents.

• The CVO PM will work alongside associates from other OhioHealth medical affairs teams, the CIN, and/or OhioHealthy to answer inquiries related to a provider's credentialing application or status within the credentialing process.

• The CVO PM will complete the credentialing assignments and ensure adherence to regulatory guidelines, including all relevant policies and procedures governing the credentialing department.

• The CVO PM will accurately identify applications that necessitate medical director review by adhering to credentialing department policies specific to the CIN and OhioHealthy.

• The CVO PM will prepare the Medical Director Review (MDR) packet and collaborate with CVO leadership whenever a review is required.

• The CVO PM will maintain confidentiality regarding all credentialing, re-credentialing, and membership matters.

• The CVO PM will engage in system-wide credentialing initiatives as identified (e.g., process improvement projects).

• The CVO PM will take part in KPI (key performance indicator) huddles as scheduled.

• The CVO PM will participate in weekly gemba meetings, including the development of information to share and presenting topics as required by the department's gemba schedule.

• The CVO PM will work autonomously with minimal supervision while meeting productivity expectations and delivering high-quality work.

⛳️ Requirements

• Bachelor's Degree (Required)

• A minimum of two years of credentialing experience in a CVO-like department, or credentialing experience with hospital medical staff/allied practitioners.

• Familiarity with physician and allied practitioner credentialing processes.

• Comprehensive understanding of TJC and NCQA credentialing requirements.

• Experience with credentialing database management (Cactus or similar credentialing database).

• Proficiency in Microsoft products.

🏝️ Benefits

• Health insurance

• Paid time off

• Professional development opportunities