Own end-to-end provider credentialing and enrollment across Medicaid, Medicare, Medicare Advantage.
Ensure credentialing policies and documentation meet payer and regulatory requirements.
Build and continuously improve credentialing infrastructure, including SOPs and policies/procedures.
Zócalo Health is a tech-enabled, community-oriented primary care organization serving people who have historically been underserved by the healthcare system. They partner with health plans, providers, and community organizations to deliver culturally competent care; they are scaling rapidly across states and populations.
Follows documented process to ensure timely processing of Primary Source Verification completion for initial and recredentialing.
Follows guidelines in alignment with all NCQA, CMS, and state requirements as related to the provider credentialing.
Works with both internal and external stakeholders to resolve complex provider credentialing issues.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers
Leads and supports the assimilation, hiring, and training process for identified de novo locations.
Oversees the orientation and training of new employees to company policies and standard operating procedures.
Manages branch operations, services, personnel performance, and office management ongoing.
Enhabit Home Health & Hospice is an equal opportunity employer. They work to promote differences in a collaborative and respectful manner and are committed to a work environment that supports, encourages and motivates all individuals.
Oversees the work of Learner Compliancy specialists and supports their development and performance management.
Ensures consistent execution of compliance workflows across all learner populations, including extended-term courses.
Monitors and evaluates team KPIs to ensure compliance targets are met or exceeded.
Nightingale Education Group focuses on higher learning in healthcare professions. They elevate education, health, and employment systems through academic achievement, personal growth, and professional development of learners, alumni, and collaborators, while serving diverse communities.
Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications.
Maintain accurate provider profiles on CAQH, NPPES and any other applicable profiles
Complete credentialing applications to add current and new providers to commercial, Medicaid, and Medicare payers
Expressable is a virtual speech therapy practice with a mission to transform care delivery and expand access to high-quality services. They are passionate advocates of parent-focused intervention, serving thousands of clients since their inception in late 2019.
Lead one of Rula’s most critical operational functions.
Own end-to-end credentialing and enrollment outcomes.
Partner across the company to ensure providers are credentialed and enrolled accurately, compliantly, and efficiently.
Rula is dedicated to treating the whole person, not just the symptoms and aim to create a world where mental health is no longer stigmatized or marginalized, but rather is embraced as an integral part of one's overall well-being. Rula is a remote-first company that values diversity, equity, and inclusion.
Responsible for quality assurance, accuracy and overall integrity of the UAS-NY assessment data and visit documentation completed by core team nurses as well as, business partners’ nurses.
Performing assessment audits, identifying trends that require staff retraining, and implementing corrective action plans in collaboration with Clinical management staff.
Responsible for ongoing orientation, training and education of Assessment Nurses conducting UAS-NY assessments, and participate in establishing educational modules for staff orientation and re-training.
Elderplan and HomeFirst are Medicare and Medicaid managed care health plans that are expanding services in response to patients' and members' needs. MJHS is a supportive community committed to excellence, respect, and providing high-quality, personalized health care services.
Lead HR operations and compliance workflows for CNA and IHSS onboarding and employment.
Oversee end-to-end onboarding of CNAs and IHSS families in EHR and HRIS systems.
Monitor and track required employment documents and credentials, maintaining complete personnel files.
Abby Care tackles the challenge of family caregiving. They train and employ family caregivers, building a tech-powered, family-first care platform to deliver care and improve health outcomes nationwide, partnering with insurance plans, healthcare providers, and organizations across the country.
Supervise, direct and evaluate a diverse group of health care professionals to assure effectiveness of care coordination activities.
Develop audit plans and tools for teams to ensure compliance with state contracts on performance metrics and to ensure member needs are met.
Interview, hires, mentors, evaluates, coaches and manage performance for a diverse care coordination team.
Humana Inc. is committed to putting health first for its teammates, customers, and company. Through Humana insurance services and CenterWell healthcare services, they aim to make it easier for the millions of people they serve to achieve their best health.
Enroll and revalidate doctors and facilities with payors.
Process applications for licensing, permits, certifications, insurances, and relevant credentialing documents.
Review incoming insurance correspondence and mail and maintain and update credentialing spreadsheets accordingly.
CHOICE is the largest provider of pediatric dental care in the Southwest United States. They pride themselves on delivering high quality care to children in their communities.
Shapes vital subfunction with strategic leadership and operational oversight.
Builds scalable processes for accuracy, timeliness, and quality of authorizations.
Collaborates across functions for data discrepancies and continuous process improvement.
Habitat Health provides personalized, coordinated clinical and social care as well as health plan coverage through the Program of All-Inclusive Care for the Elderly (“PACE”) in collaboration with their leading healthcare partners, including Kaiser Permanente. They build engaged, fulfilled care teams to deliver personalized care in their centers and in the home.
Support the Medical Staff Services Credentialing team.
Collect, verify, and maintain accurate records within the Credentialing system.
Perform other administrative duties as assigned.
Cooper University Health Care is committed to providing extraordinary health care. Their professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols.
Provides direction and support for on-going program development.
Aligns multiple departments and staff to foster interdepartmental collaboration across the full continuum of care.
Develops program goals and objectives to ensure efficient and cost effective operations consistent with the program's mission and standards.
University of Utah Health is focused on enhancing the health and well-being of people through patient care, research, and education. As a Level 1 Trauma Center, they are nationally ranked and recognized for their academic research, quality standards and overall patient experience.
Oversee the RN Reviewer team including one RN Team Lead
Manage the daily timeliness report and ensure all cases meet expected turnaround times
Monitor the nurse productivity reports daily and provide feedback to the nurses, managing performance to ensure consistency
Cohere Health's clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics. They work with over 660,000 providers and handle over 12 million prior authorization requests annually.
Provide high-quality, evidence-based primary care via telehealth.
Help establish and maintain a QA program.
Serve as a Pod Lead for a group of clinicians.
Vitable is a health benefits platform that makes healthcare better for employers of everyday workers, bringing accessible, high-quality care to millions. They are growing rapidly and looking for eager team members who are hungry for change and passionate about delivering better care.
Lead an exhaustive audit of clinical and business operations to identify and remediate regulatory vulnerabilities.
Act as the authorized signatory for all legal compliance documents.
Partner with Product and Engineering to embed "Compliance by Design" into the patient platform.
Wheel is evolving the traditional care ecosystem by equipping the nation's most innovative companies with a premier platform to deliver high-quality virtual care at scale. They offer proven strategies and cutting-edge technologies to foster consumer engagement, build brand loyalty, and maximize return on investment.
Enhance healthcare quality by overseeing performance improvement initiatives.
Ensure compliance with regulations and support data analysis.
Monitor quality metrics and drive projects to improve healthcare outcomes.
Jobgether is a platform that connects job seekers with potential employers, using AI to match candidates with roles. They focus on ensuring applications are reviewed fairly and efficiently.
Provide direct supervision, coaching, and performance oversight to clinical managers.
Serve as a primary operational liaison between clinical teams and health plan care management teams.
Oversee onboarding and training for care teams and clinical managers.
Tuesday Health is a value-based palliative care provider group dedicated to transforming serious illness and end-of-life care. They deliver goal-centered care focused on alleviating physical symptoms and emotional stress for individuals and their caregivers. They cultivate a dynamic and inclusive team environment.