Credentialing Program Manager

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Job Description Summary:

The Central Verifications Office Credentialing Program Manager (CVO PM) reports to the Director of CVO & Network Operations. The CVO PM ensures that practitioners (physicians, podiatrists, dentists, psychologists and allied practitioners) are properly credentialed in order to comply with applicable legal, professional and regulatory requirements. The CVO PM manages and coordinates the credentialing and recredentialing process for all applicants to the OhioHealth Medical Staff, Allied Practitioner Staff, the Clinically Integrated Network (CIN), and/or the OhioHealthy Medical Plan. The CVO PM is responsible for managing all aspects of the credentialing process that include an extensive knowledge of both The Joint Commission (TJC) and National Committee for Quality Assurance (NCQA) policies and procedures.

Minimum Qualifications:

Bachelor's Degree

• Years of experience: 2

SPECIALIZED KNOWLEDGE

• Minimum of two years credentialing experience through a CVO-like department, or hospital medical staff/allied practitioner credentialing experience.
•   Knowledge of physician and allied practitioner credentialing processes.
• Detailed understanding of TJC and NCQA credentialing requirements. 
• Credentialing database management (Cactus or similar credentialing database).  Familiarity with Microsoft products.

DESIRED ATTRIBUTES

Outstanding communication skills, both written and oral; strong organizational skills and attention to detail.  Open to feedback.  Is an autonomous worker (work from home environment).  Ability to work in a fast-paced environment and adaptable to change.  Provides excellent customer service and exhibits strong professionalism. 

RESPONSIBILITIES AND DUTIES

90%

The CVO PM manages and coordinates the credentialing and recredentialing process for all applicants to the OhioHealth Medical Staff, Allied Practitioner Staff, the CIN, and/or the OhioHealthy Medical Plan.  The CVO PM will utilize three sets of credentialing policies and procedures managed by the CVO to support TJC accreditation for the OhioHealth hospitals and NCQA accreditation to support the CIN and OhioHealthy Medical Plan. 

The CVO PM is accountable for ensuring all information is accurate and up to date prior to completing an application.  The CVO PM will collaborate with applicants and/or credentialing contacts to resolve discrepancies in application documents. The CVO PM will collaborate with associates of other OhioHealth medical affairs teams, the CIN and/or OhioHealthy to address questions related to a providers credentialing application or status in the credentialing process. 

The CVO PM will complete the crede