If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm) This position will lead the credentialing group for multiple markets within OptumCare Care Delivery. Responsible for all administrative aspects of credentialing functions so that they are able to meet medical group, plan to plan, health plan and National Committee for Quality Assurance (NCQA) requirements. Position is responsible for the development, effective coordination and maintenance of the Credentialing program, working closely with the Credentialing Committee. Oversees the work of Credentialing Supervisor, Credentialing Leads and Specialists, who are responsible for the day to day activities of the department, including initial application processing, recredentialing, practitioner updates and audit preparation, etc. Oversee interfaces and interdependencies between departments, consistently maintaining knowledge and understanding of the impact to providers. Manage relationships with health plan credentialing personnel, including those who delegate credentialing. Support the strategic network and payer goals of the organization. Primary Responsibilities: Oversees the regional operations of the credentialing department for both employed and contracted physiciansEnsure that program meets health plan delegation requirements, NCQA standards, state and federal lawsWork with payers to support delegation audit and oversight activitiesOrganize and oversee external delegation oversight audits by health plans, NCQA and/or governmental agenciesInteract with contracting team, both regionally and locally, on an on-going basis, planning monitoring and tracking credentialed network providers Draft and maintain Credentialing program, policies and procedures and credentialing process as directed by leadership, including the Credentialing Committee's and/or Medical Leadership. Obtain annual review and approval by the Credentialing Committee and Medical Leadership of all Credentialing policies and procedures to meet health plan delegation oversight requirements, NCQA standards, state and federal laws, medical group, and health plan requirementsOversees the quality control of the credentialing processConducts audits of the credentialing database, confirming accurate input of provider data, including auditing other staff data entry and verifying accuracy of modifications made to the database. Monitor security of data within the Credentialing Database with individuals to whom data or system access may be given; report infractions to the Vice President of OperationsResponsible for oversight of provider directory functions including accuracy of provider lists that are provided to payers and patientsWorks with Regional leadership to support strategic and operational goalsDevelops leadership team to ensure that they continue to develop professionally and progress as leaders within the organizationIndependently resolves issues; brings solutions to internal leadership when appropriateManages current knowledge of database software capabilities. Collaborates with other Care Delivery Organizations to develop strategic development of enterprise credentialing and contract management platformOn board new staff to appropriate policies, procedures, guidelines, database use, capabilities, security, etc. Provides performance coaching and is responsible for mid cycle and annual performance evaluations for supervised staff. Provides leadership to the team to ensure priorities are mePartners with Finance, Optum Technology, Optum Operations and other parts of the organization to ensure projects are on time, on budget and meet business expectationsAccepts and performs other duties and responsibility as assigned
Required Qualifications: 4-year college degree, health care related field preferred or equivalent work experience 6+ years of experience in credentialing, preferably in a managed care setting 4+ years of management / supervisory experience Must be Certified Provider Credentialing Specialist or Certified Medical Services Management Advanced Access and Excel Knowledge Proficient in Power Point Must be fluent in NCQA accreditation guidelines and have a working understanding of CAQH Preferred Qualifications:Knowledge of Practice Management Software, PowerPoint and eVIPs Software System Strong knowledge of managed care systems and contract related activities including; legal, regulatory and operational Strong problem solving and decision making skills Ability to organize and prioritize multiple competing priorities A proven track of building and fostering relationships at all levels of the organization Ability to drive and execute upon department / business prioritiesCareers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm) Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: Associate Director, Contracting, provider contracting, healthcare, management, Las Vegas, NV, Nevada
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.