Manager Credentialing

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Job Information
Humana
Manager, Credentialing
in
Cincinnati
Ohio
Description
Responsibilities
The Manager, Certifications Operations
reviews the applicant's education, training, clinical experience, licensure, accreditation, certifications, professional liability insurance, and other TRICARE requirements according to provider type. Reviews the information and documentation collected, as well as verification that the information is accurate and complete. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.
KEY ACCOUNTABILITIES
Oversees a team of certification and credentialing professionals that to ensure required certifications are timely and conducted in accordance with contract requirements.
Work collaboratively with credentialing leaders to determine any course of action, which would require a corrective plan for any of the requirements within the TOM.
Researches provider certification and credentialing issues and recommends changes that assure compliance with contract obligations
Collaborate with leaders across the enterprise to strategize and establish policies and procedures to address inappropriate provider behavior and determine appropriate corrective actions
Collaborate on communications, educational materials, development and performance requirements
Maintain training documents, job aides and assist in ensuring documents are updated as needed for process changes.
Other duties as required
This position description in no way states or implies that the key accountabilities above are the only ones being performed by the individual(s) with this role description. The individual(s) may be called upon and required to follow other instructions or perform other duties and tasks requested by his or her supervisor, consistent with the purpose of the position, department and/or company objectives
Required Qualifications
Bachelor's degree
5 plus years of experience working within a healthcare setting
2 or more years of proven leadership skills and significant experience directly managing a group of seasoned professionals
Demonstrated success working in collaboration with multiple departments and disciplines
Strong computer skills including MS Office desktop applications (Word, Excel, PowerPoint, Visio, Project)
Demonstrated competency in both oral and written communication skills
Solid understanding of process / work flow concepts
Excellent interpersonal and teamwork skills
Our Department of Defense Contract requires U.S. citizenship for this position
Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)
For this job, associates are required to be fully COVID vaccinated, including booster or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve
If progressed to offer, you will be required to: Provide proof of full vaccination, including booster or commit to testing protocols OR
Provide proof of applicable exemption including any required supporting documentation
Medical, religious, state and remote-only work exemptions are available
Work at Home/Remote Requirements
Must ensure designated work area is free from distractions during work hours and virtual meetings
Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended to support Humana applications.
Preferred Qualifications
3 plus years of experience in provider credentialing and/or certification
Current/Prior TRICARE knowledge and experience
Strong technical skills with Access or SQL
Master's Degree in Business, Healthcare administration or related fields
Additional Information
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours
40

Company info

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