Manager of Credentialing - The Health Plan

 
Position: Manager of Credentialing - The Health Plan

Job ID: 148659

Location: US-TX-Bellaire

Department: CREDENTIALING MANAGEMENT

Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5p Monday - Friday

About Texas Children's Hospital

The Texas Children’s Hospital system is the largest pediatric integrated care system and is an industry leader in pediatric population health.    Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children and pregnant women.  We are an Integrated Community System providing holistic care that empowers families to live healthier lives.  Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.  Currently, the Health Plan serves more than 450,000 members across three state territories (Harris, Jefferson, North East), who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. To join our community of 13,000 dedicated team members, visit www.texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at www.infinitepassion.org

Summary:

We are searching for a Manager of Credentialing– someone who works well in a fast-paced setting. In this position, you will be responsible for maintaining the Practitioner and Facility Credentialing Program for the hospitals health plan; to maintain policies and processes in compliance with all applicable federal, state and nationally recognized regulatory and/or accrediting bodies; and to oversee credentialing staff in the preparation of all credential files and reports to ensure compliance.

Think you’ve got what it takes?



Responsibilities :

Job Duties and Responsibilities

 

  • Manages a Credentialing Program that meets regulatory and accrediting body requirements
  • Responsible for Credentialing responses to regulatory audits
  • Responsible for training of Health Plan Credentialing staff to ensure a comprehensive, up to date knowledge base for identifying potential quality, regulatory, or malpractice issues early in credentialing process
  • Responsible for credentialing and re-credentialing functions for practitioners seeking to enter the network through direct credentialing and contracting with hospital Health Plan
  • Responsible for oversight of credentialing and re-credentialing functions for practitioners contracted through an entity to whom Health Plan has delegated credentialing
  • Responsible for maintaining a current and accurate database of all credentialed practitioners
  • Responsible for timely, accurate credentialing reports


Qualifications:

Requirements

 

  • Associate's Degree
  • 5 years credentialing experience
  • MESM - Medical Staff Manager and Leadership/managed care experience preferred


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