Credentialing Manager jobs in New Jersey

Overview

Our team members are the heart of what makes us better.

At Hackensack Meridian Health we help our patients live better, healthier lives - and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It's also about how we support one another and how we show up for our community.

Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.

As Delegated Credentialing Manager, you are responsible for overseeing all credentialing functions including pre-delegation and annual due diligence audits and monitoring of practitioner and delegated credentialing activities to ensure compliance with National Committee for Quality Assurance (NCQA), contractual agreements, and State and Federal requirements. The Delegated Credentialing Manager position will function in a hybrid work environment, carrying out job responsibilities remotely and in part onsite if needed.

This is 100% Remote position

Responsibilities

A day in the life of a Delegated Credentialing Manager at Hackensack Meridian Health includes:

• Lead the oversight of all delegated activities to ensure compliance with CMS, and NCQA requirements.
• Responsible for ensuring thorough preparation of documentation, reports and any other information needed for regulatory and NCQA audits related to delegation oversight.
• Coordinate communication with delegates regarding regulatory and NCQA audits.
• Serve as the subject matter expert in interpreting compliance and regulatory requirements
• Implement and maintain a comprehensive delegation oversight program which supports all aspects of credentialing delegation,
• Monitor delegates and internal business owner relationships to ensure compliance and optimal delegate performance and achievement of business goals according to service level and other contractual requirements.
• Responsible for the management of delegation performance, including monthly, quarterly, annual performance reporting and Corrective Action Plans (CAP)
• Direct pre-delegation audits, annual audits, required reporting and ongoing oversight of delegates.
• Evaluates and modifies existing oversight programs, requirements and criteria to ensure meets ongoing business requirements.
• Lead the development and maintenance of delegated related policies and procedures.
• Initiate implementation of new or changed regulatory and/or accreditation requirements to ensure the adequacy of controls of oversight activities.
• Chair the Delegation Oversight Committee and taking appropriate committee minutes
• Any other duties as required to ensure Health Plan operations are successful.
• Supervises work of others, including planning, assigning, scheduling and reviewing work, ensuring quality standards. Is responsible for hiring, terminating, training and developing, reviewing performance and administering corrective action for staff. Plans organizational structure and job content.
• Collaborates with CVO leaders in support of an ongoing performance improvement and reporting process that is accurate, timely and action driven.
• Provides and supports ongoing communication with CVO leaders especially in regards to risk/issues identified during the credentialing/recredentialing process for delegated credentialing.
• Contributes and supports technology integration and migration with other system information systems as needed.
• Provides support to CVO Director for interpretation, development, and implementation of all systems and functions to ensure continuous compliance with state and federal law, organization policies, regulatory agencies and accrediting body standards [CMS, JC, NCQA, HFAP, DNV, AAAHC, URAC, as applicable.].
• Develops and provides ongoing education to the team.
• Manages audits, findings and reports.
• Participates on compliance teams and in regulatory and accreditation surveys.
• Supports education, professionalism, practice-based learning and systems-based learning
• Provides support to the department for recruiting, training, mentoring, evaluating and disciplining staff assigned to the Delegated credentialing team.
• Cultivates positive interpersonal relationships with clients, medical services professionals, practitioners, ancillary staff and senior management.
• Provides initial orientation and ongoing education to designated team members on delegated credentialing processes, software, self-audits, and other education as needed.
• Consistently performs environmental surveillance to identify new opportunities for designated team and Delegated Credentialing Department.
• Consults with MSPs (Medical Services Professionals in MSOs, MCOs, CVOs, etc), individual Practitioners, HMH Leaders.
• Other duties and/or projects as assigned.
• Adheres to HMH Organizational competencies and standards of behavior.

Qualifications

Education, Knowledge, Skills and Abilities Required:

• Bachelor's degree in health care administration or related field. Four years healthcare experience in lieu of a degree will be considered.
• 5 years in industry delegated credentialing setting in multi-hospital system.
• 2 years in management/supervisory role.
• Takes accountability, uses initiative, possesses critical thinking skills, uses good judgment, seeks guidance as needed.
• Strong interpersonal skills, teamwork and communicates effectively.
• Ability to effectively interact with populations of patients/customers with an understanding of their needs for self-respect and dignity.
• Overall working knowledge of software programs with a drive to incorporate technology in all operational functions.
• Strong organizational skills.
• Detail driven.
• Excellent communication skills.
• Gets results.
• Drives service excellence.

Licenses and Certifications Required:

• Certified Professional in Medical Services Management or Certified Provider Credentials Specialist with ongoing maintenance of certification.

If you feel that the above description speaks directly to your strengths and capabilities, then please apply today!

Our Network

Hackensack Meridian Health (HMH) is a Mandatory Influenza Vaccination Facility

As a courtesy to assist you in your job search, we would like to send your resume to other areas of our Hackensack Meridian Health network who may have current openings that fit your skills and experience.