[Hiring] Credentialing Program Manager @OhioHealth

Role Description

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.

• Manage and coordinate the credentialing and recredentialing process for all applicants.
• Utilize credentialing policies and procedures to support TJC and NCQA accreditation.
• Ensure all information is accurate and up to date prior to completing an application.
• Collaborate with applicants and credentialing contacts to resolve discrepancies.
• Work with associates of other OhioHealth medical affairs teams to address questions related to credentialing applications.
• Complete the credentialing assignment and ensure compliance with regulatory guidelines.
• Identify applications requiring medical director review and prepare the Medical Director Review (MDR) packet.
• Maintain confidentiality for all credentialing/re-credentialing/membership issues.
• Participate in system-wide credentialing initiatives and KPI huddles.
• Participate in weekly gemba meetings and develop information for presentations.
• Work independently while meeting productivity expectations and maintaining high-quality work.
• Focus on safety, quality, and efficiency as part of a High Reliability Organization (HRO).

Qualifications

• Bachelor's Degree (Required)
• 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.

Requirements

• Outstanding communication skills, both written and oral.
• Strong organizational skills and attention to detail.
• Open to feedback.
• Ability to work autonomously in a work-from-home environment.
• Ability to work in a fast-paced environment and adapt to change.
• Excellent customer service and strong professionalism.

Benefits

• Work in a caring environment.
• Opportunity for lifelong learning.
• Strive for excellence in the healthcare industry.

Company Description

OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants based on various protected characteristics.