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Manager II, Credentialing – BioPlus Specialty Pharmacy
Elevance HealthManager II managing credentialing processes for BioPlus Specialty Pharmacy. Ensuring compliance with standards and overseeing provider contracts with a focus on team performance.
About the role
Key responsibilities & impact- Develops, implements and controls the credentialing process for all in-house professional provider consultants and all contracted providers within the region
- Provides guidance regarding policies, procedures and regulatory requirements
- Ensures that all legal, licensure and accreditation standards are met
- Reviews the approval and termination of professional provider contracts as they relate to the credentialing process
- Ensures the accurate and timely information for the purposes of re-credentialing, data analysis and directory generation as well as recommending changes to the credentialing criteria and processes
- Monitors all governmental and private agency initiatives in the credentialing area
- Ensures all credentialing and re-credentialing policies and processes are in compliance with NCQA and all applicable state regulations
- Assures credentialing activities are integrated within the appropriate QI committees and departments
- Hires, trains, coaches, counsels and evaluates performance of direct reports
Requirements
What you’ll need- Requires a BA/BS degree in Business Administration, Health Science, medical records or related field
- a minimum of 3 years management and credentialing experience; or any combination of education and experience, which would provide an equivalent background
- Managed care experience and MBA or MHA degree strongly preferred
- People leadership experience strongly preferred
Benefits
Comp & perks- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical
- dental
- vision
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
credentialing processdata analysiscontract managementaccreditation standardslicensure compliancepolicy developmentregulatory requirementsquality improvement (QI)re-credentialingperformance evaluation
Soft Skills
people leadershipcoachingcounselingguidancecommunicationtrainingevaluationteam managementorganizational skillsproblem-solving
Certifications
BA/BS degreeMBAMHA