Shire Jobs

Mobile Shire Logo

Job Information

Somatus Manager, Licensing & Credentialing in Boise, Idaho

Manager, Licensing & Credentialing at Somatus

Remote

Summary:

The Manager, Licensing & Credentialing reporting to the AVP, Quality, is accountable for leading and overseeing the collection of provider data and information to support the organization’s credentialing and payer enrollment operations.

Essential Duties and Responsibilities:

  • Develop credentialing processes and procedures, overseeing day-to-day implementation.

  • Monitors process, and document all provider licenses and renewals, as well as credentialing for all state Medicaid and health plans accurately and in a timely manner prior to expiration.

  • Monitor credentialing & licensing statuses for all licensed clinical providers, tracking re-credentialing requirements and creating new workflows as needed.

  • Oversees provider and staff license applications and credentialing forms and gathers required supporting documents, fees, and signatures within required timeline for state board approval.

  • Research and document required licenses and credentialing for company.

  • Assist in resolving licensing and credentialing issues as needed.

  • Maintain current and appropriate knowledge of provider licensing practices and Medicaid deadlines.

  • Oversee all Health Plan applications when requesting contracting.

  • Design and improve the administrative aspects of provider onboarding to ensure the proper applications are initiated during the hiring process and providers have an outstanding experience.

  • Research and track state licensing and supervisory requirements for all states in which Somatus does business (MD, DO, NP, PA, Medical Assistant, Nursing, Registered Dietitians, and Social Workers)

  • Track: CME requirements, supervisory agreements and regulations, licensure renewal and status, network status for providers

  • Overseeing the completion of:

  • All new license applications, as well as tracking & completing license renewal,

  • Payor enrollment applications,

  • CIN applications for individual providers or the group,

  • CLIA and business certifications,

  • TIN and set up,

  • Medicare number acquisition, and

  • Provider CAQH ProView profile

  • Provide project management support to care team leadership on related projects; these additional activities could include work focused on onboarding, training, and/or professional development for the care team.

  • Serve as a subject matter expert for provider and staff licensing and credentialing.

  • Responsible and accountable for maintaining compliance with all contractual obligations, state regulations and NCQA standards for activities related to the areas of responsibility.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Required Education and Experience:

Required

  • Bachelor’s Degree, or other comparable healthcare

  • Three (3) to five (5) years’ management in healthcare setting, inpatient and/or outpatient.

  • Three (3) to five (5) years’ experience in healthcare credentialing with direct provider interaction.

  • Three (3) to five (5) years of successful work experience leading credentialing operations and managing teams.

  • Experience in structuring and executing complex analyses to support strategy in a fast-paced, evolving environment.

  • NCQA accreditation survey experience, including submission of documents to accreditation

  • Health plan auditing.

Preferred

  • Master’s Degree in Business Administration, Certified Professional in Healthcare Risk Management, or advanced degree.

  • Certified Provider Credentialing Specialist (CPCS).

  • Certified Professional Medical Services Management (CPMSM).

Knowledge, Skills, and Abilities:

  • Knowledge and understanding of local, state, federal laws and regulations pertaining to guidelines from Medicaid.

  • Ability to document and analyze complex business requirements and processes.

  • Ability to manage complex projects and catalyze and energize teams with clear plans, accountabilities, and teamwork to efficiently execute.

  • Ability to interface with Senior Level Executives during client meetings I presentations.

  • Must be a proactive, hands-on leader with a proven strategic vision who will drive operational performance with a high degree of accountability and integrity.

  • Strong financial & data acumen – detail orientated, precision & proven track record managing budgets.

  • Ability to be both a strategic and tactical change agent in the healthcare space.

  • Self-starter who will take initiative and be proactive when there are multiple priorities.

  • Strategic solution-seeker who sees opportunities when others see barriers.

  • Strong interpersonal skills and ability to communicate effectively.

Physical Requirements

  • This job operates in a professional office setting. While performing the duties of this job, the employee is regularly required to sit or stand for extended periods of time. Normal manual dexterity is required.

  • Normal speaking and hearing abilities to interact with others in an office environment, over telephone or other video conferencing platform.

  • The employee is occasionally required to stand; walk; and reach with hands and arms and continuously repeat the same hand, arm finger motion many times as in typing.

OTHER DUTIES:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Our priority is the health and safety of our members, colleagues, partners, and community. Proof of COVID-19 Vaccination is required for employment. If you are unable to be vaccinated for medical reasons or sincerely held religious beliefs, we will consider requests for reasonable accommodations consistent with our policy, and where we are able to provide such accommodations without undue hardship to the company pursuant to applicable law.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions .

Somatus, Inc. provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law. Further, the company takes affirmative action to ensure that applicants are employed, and employees are treated during employment without regard to any of these characteristics. Discrimination of any type will not be tolerated.

DirectEmployers