Job: Credentialing Supervisor - Quality Management

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Jobing Description

Category: Leadership/Management
Facility: Phoenix Health Plan/Abrazo Advantage Health Plan
Department: Quality Management
Schedule: Full Time
Shift: Day Shift
Hours: 80
Job Details:Overview: The purpose of this position is to supervise the credentialing and medical record review staff and assist with special projects within the Quality Management department. Duties including but not limited to assistance with policy and procedure development. Development of desktops to meet federal and state requirements. Daily operational oversight of credentialing staff, management of special projects within the department . Identification and assistance with system enhancements and testing. Working with Network Management, prior authorization, concurrent review, pharmacy, member services, and other internal departments as required. Assistance with program development and auditing for credentialing and peer review, provider reporting and credentialing committee. Primary duties include:
Assists manager with development and implements programs compliant with State and Federal regulations related to credentialing and quality management including daily oversight of credentialing and development of metrics. Works with QM manager for program compliance
Supervises credentialing and QM staff, documents audits for compliance with desktops, policies and procedures
Assists with development and revision of credentialing and QM policies and desktops.
Communicates new information obtained through training, out-side courses, lectures, programs, etc. to peers for educational purposes.
Ensures coaching training for assigned staff.
Acts as a department trainer and resource
Maintains and promotes confidentiality of patient information and adheres to all HIPAA regulations.

Special Skills: Required 5-10+ years of Managed Care in a Commercial, Medicare, or Medicaid environment.. Required understanding of state and federal regulations, knowledge of medical terminology, excellent interpersonal communication and customer skills. Proficient at Word, Excel, Use of ACCESS databases. Proficient at credentialing systems. Experience managing process and system improvements.

Minimum Requirements: Bachelors degree or equivalent required. Minimum of five (5) years of Managed Care experience with skills including project management, systems, training and supervision of people, groups or project.
Preferred Qualifications: Bachelors or Masters degree and/or experience within a Medicare, commercial or Medicaid health plan for 10+ years and ability to critically think. Two to five (2-5) years prior credentialing experience.

Skills / Requirements

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