Credentialing Services Project Manager

Job Description

Job Description

Summary

Under the general direction of the Quality Management VP, the Project Manager’s primary responsibility is to provide project leadership, direction, and support to ensure credentialing projects achieve stated goals and objectives. This includes but is not limited to credentialing audits, credentialing reports and software implementation. The Project Manager is responsible for all aspects of project management, including project analysis, project planning, scheduling/timelines, milestones/deliverables, reporting, tracking, risk/issue management, and delivery of assigned projects. Although this is currently a remote position, there may be some occasional onsite needs.

Duties and Responsibilities

1. Maintain credentialing audit calendar to include health plan due dates and task assignments.

2. Verify virtual audit submissions are sent timely; attend exit interviews to establish additional documentation or CAP requirements.

3. Attend virtual real time audits to establish additional documentation or CAP requirements.

4. Assist as necessary to ensure timely annual P & P development with requisite signatures.

5. Work with compliance department to ensure that all delegation signatures are obtained timely.

6. Review Credentialing P & P appendices to update material as appropriate in accordance with health plan and regulatory compliance standards.

7. Contribute Areas of Concern documentation to QM Leadership so that it can be included timely for the monthly Board Meetings.

8. Establish Subdelegation and Health Delivery Organization (HDO) material timelines and ensure that cadenced documents are received.

9. In conjunction with credentialing Subject Matter Experts (SME), develop, execute, and monitor corrective action plans within the Credentialing team.

10. Manage internal and external stakeholder communications; ensure timely communication with project teams, leadership, and other project stakeholders regarding status updates and issues that may arise.

11. Design, develop, manage, support, and lead projects impacting the credentialing team.

12. Perform detailed analysis of data, workflows, policies, procedures, organization of staff, and skills to execute initiatives. Initiatives may include process automation and/or workflow improvement.

13. Prioritize and manage multiple competing requests through effective organization and communication.

14. Liaison for needed reports from internal MPM departments or health plans including responsibility for understanding data presented.

15. Setup and maintain SmartSheets as needed to complement team projects or processes.

16. Investigate and validate improvement opportunities identified.

17. Exercise independent judgment in developing methods, techniques, and evaluation criteria for obtaining results.

18. Provide input into designing strategies for alignment with business unit goals and objectives.

19. Attend administrative meetings to provide and receive input concerning activities for the organization; this may include the Prioritization Committee and/or QM-Compliance meeting among others.

20. Proactively identify, resolve, and escalate (as needed) projects/program risks and issues.

21. Resolve complex issues and ensure task completion by establishing priorities.

22. Miscellaneous projects as assigned by QM Leadership to support the Credentialing department.

23. Adhere to MedPOINT Management’s core values: Accountability, Community, Celebration, Integrity, Innovation & Collaboration.

Minimum Job Requirements

· Intermediate to advanced proficiency with Microsoft Office products (Word, Excel, PowerPoint, Visio, SharePoint)

· Experienced in meeting facilitation

· Advanced knowledge of Microsoft Excel skills and/or Smart Sheet

· Ability to identify, analyze, and interpret trends or patterns

· Understanding of credentialing process in management care environment a plus

· EZ-CAP, Gemini G1 knowledge a plus

· College degree or commensurate experience required

· Health plan, managed care or credentialing experience preferred

Skill and Abilities

· Highly organized and able to handle multiple priorities

· Excellent written and verbal communication skills

· Ability to deliver on departmental and company goals

· Ability to work effectively with all levels of the organization and stakeholders

· Proven history of timely project delivery.