- Req #:
- Job Location(s):
- Brooklyn, NY
- Zip Code:
- Management - Non-Clinical
- Regular Full-Time
The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.
Why work for MJHS?:
When you work with us you will receive comprehensive and affordable health and financial benefits, in addition to generous paid vacation, personal and holiday time that you won't find at our competitors. Do you receive a paid day off for your birthday now? No? You will here! You will also receive the training, tuition assistance and career development you desire to help you achieve your career goals. You take care of our patients, residents and health plan members, and we will take care of the rest!
- Tuition Reimbursement for all full and part-time staff
- Generous paid time off
- Affordable medical, dental and vision coverage for employee and family members
- Two retirement plans! 403(b) AND Employer Paid Pension
- Flexible spending
- And MORE!
Provide leadership and oversee the overall operations, processes and resources for the Credentialing and Provider Data Management (PDM) Team within the Network, Planning and Operations (NPO) department. Ensure the Teams have established workflows for all aspects of the Credentialing and PDM end to end lifecycle. Oversee monitoring of all provider data auditing and implements continuous operational improvements in a proactive manner.
- 5-7 years of experience in a managed care setting.
- Knowledge of CMS (Medicare, Medicaid) and state and federal regulations (NYSDOH, DFS, OIG, OMIG, etc.).
- Established track record in health care, specifically in Credentialing and PDM with career progression.
- Experience using credentialing software (i.e CACTUS) and direct hands on CAQH experience.
- Strong Knowledge of Credentialing requirements (CMS and NYDOH)
- Strong Knowledge of Provider Data requirements (CMS and NYDOH)
- Experience managing the systems used to support the operation: Healthrules Payor, CACTUS (Symplr), Tract Manager (Symplr), Quest Analytics.
- Knowledge of NCQA, CMS, JCAHO and/or quality requirements. CPCS or CPMSM certification preferred.