Network Operations

• Oversees NCQA accreditation by the National Committee for Quality Assurance and regulatory compliance; maintains oversight of NCQA credentialing policies; ensures compliance with regulatory guidelines.
• Serves as an administrator for the Network Operation Entity in the Credentialing software; field questions and evaluate permission requests for end users.
• Supports selection and implementation of credentialing software systems/enhancements; trains staff on new platforms.
• Oversee enrollment function for OH-Independent Medical Group or transferring from a TIN previously in the CIN; ensure enrollment with CIN and OhioHealth payers including Medicare/Medicaid prior to go-live.
• Coordinates CIN Membership Committee activities: CIN Medical Director Review, Provider Network Development Committee, Credentials Committee and Peer Review Committee; prepare and distribute credentialing docs, agendas/minutes.
• Provide regulatory guidance to CIN Medical Directors and follow-up on reviews.
• 40% Leadership: planning and decisions; servant leadership and collaboration with OhioHealth leadership, CVO, OH-Independent Medical Group administration, legal counsel, and other stakeholders; Population Health involvement; professional development; adaptability.
• 10% Additional Network Operations Support: optimize workflows, identify bottlenecks, implement streamlined processes, utilize data analytics to track KPIs, produce reports (e.g., Qlik, turnaround time, CI Monitoring, Eligibility).

Network Operations Manager

Job Level

About the role

Requirements

Senior Patient Accounting Specialist

Patient Accounting Spec

Associate Clinical Director

Department Analyst I – Credentialing

Senior Analyst, Health Care Quality Management