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Role Overview:
- Under general supervision, manage all functions related to credentialing and recredentialing of practitioner applicants.
- Ensure the provider network meets regulatory criteria to minimize liability and maximize member safety.
Key Responsibilities:
- Perform detailed application reviews and primary source verifications (PSV) while meeting production goals.
- Investigate discrepancies, communicate with practitioners, and maintain credentialing database accuracy.
- Monitor expirables and review sanction/exclusion reports to take appropriate action.
Qualifications:
- High school diploma required; Associate degree preferred.
- 1-4 years of hospital or insurance plan credentialing experience.
- Knowledge of Joint Commission, NCQA, URAC, and HFAP standards; CPCS certification preferred.
Curana Health
Curana Health provides value-based care solutions, including on-site primary care, Accountable Care Organizations, and Medicare Advantage plans, to senior living communities and skilled nursing facilities. Founded in 2021, the company has grown to serve over 200,000 seniors across 1,500+ communities in 32 states, employing more than 1,000 clinicians and staff, and was ranked #147 on the Inc. 5000 list of fastest-growing private companies.