MSLA is a Medical Corporation that provides comprehensive independent medical evaluations (IME) and other IME related services to the government and private industry. Our business philosophy incorporates both exceptional customer service and quality evaluations, both of which are the primary factors for our rapid growth since our inception in 1998. No industry is moving faster than health care. And no organization is better positioned to lead health care forward. We need attention to every detail with an eye for the points no one has considered. The rewards for performance are significant. You'll help improve the health of millions. And you'll do your life's best work.(sm) The Manager of Credentialing will work closely with MSLA leadership to establish and implement standard policies, procedures, processes and best practices across the organization to promote compliance with applicable State & Federal laws and contractual obligations in regards to MSLA's practitioner network. This individual will monitor changes to laws and regulations to ensure compliance with State & Federal laws, regulations and mandates for all practitioner types. This individual is responsible for managing and overseeing the certification of NCQA standards and ensuring that NCQA methodologies are incorporated and integrated into all standard policies, procedures, processes and best practices across the network. The Manager of Credentialing will oversee a team that supports the network through the following avenues: Credentialing of Practitioners, Credentialing of MSLA Employees, Compliance of Practitioners, Delegation of Credentialing, Management of Practitioner Network and Accreditation and Regulatory Change Management. This individual will serve as the subject matter expert on credentialing, regulatory change management, delegation and management of all network practitioners for the organization. Primary Responsibilities:Management of practitioner database, credentialing/re-credentialing process, delegation arrangements, provider relations. Strategic planning and oversight of metric reporting for Credentialing DepartmentManage the development, implementation and maintenance of the credentialing procedures and processes to ensure overall compliance of provider networkManage the selection, hiring, training, development, performance assessments, disciplinary actions and coaching for staff. Provide guidance to staff on inquiries, concerns, complaints appeals and grievances relevant to the credentialing policies and processesLeads and provides oversight on projects, process improvement initiatives and contract change requirementsManagement of department budget and performance, identification of adjustment/changes as necessary to uphold operational quality and financial performance
Required Qualifications:Bachelor's degree or equivalent combination of education and relevant credentialing experience5+ years of experience with credentialing / re-credentialing and / or privileging in the health care industry3+ years of experience with health care accreditation and regulatory standards including CQA requirements3+ years of leadership experienceExperience in monitoring and managing external audits (DoD, NIOSH, NCQA, URAC)Experience in monitoring all delegation audits performed on external providersPreferred Qualifications:Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information form othersStrong interpersonal skills, establishing rapport and working well with othersStrong customer service skillsAbility to perform detailed work with a high degree of accuracy; strong analytical thinking; multi-tasking, organizational and time management skillsMust be able to problem solve and propose solutions; ability to demonstrate an appropriate level of assertiveness in performing work responsibilities under extreme deadlines Careers with MSLA. Our focus is simple. We're innovators at providing technology - driven, comprehensive, independent medical evaluations to government and private entities. In addition to our core clinics located throughout California, Nevada and Hawaii, we manage an extensive nationwide network of fully credentialed physicians in all major specialties. We've joined Optum, part of the UnitedHealth Group family of businesses. And when you join our team, you'll impact the lives of others by verifying the validity of claims, providing quality examinations and meeting the timelines that make a difference for our customers. Here, you'll join a team that makes you want to do better every day, resulting in your life's best work.(sm) https://www.mslaca.com/ Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: MSLA, Credentialing Manager, Cypress, CA, California
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.