Manager Network Operations

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Job Description Summary:

The Manager, Network Operations under the Central Verification Office (CVO) and Network Operations Department reports to the Director of CVO and Network Operations and oversees all operational aspects of the Network Operations section of the department and provides secondary support for processes and procedures related to credentialing. Responsibilities include adherence to accrediting body regulations; management oversight to staff; and establishing, organizing, and implementing procedures related to network operation functions.

The Manager of Network Operations assures adherence to policies and procedures, assures compliance with regulatory agencies, and develops systems and monitors performance related to quality. The Manager also supports the Director with planning and coordinating daily work with the Network Operations team as it pertains to quality and compliance. The Manager also has primary oversight for the execution of credentialing and enrollment as it pertains to OH Independent Medical Group.

Responsibilities And Duties:

50% Administrative Management Oversight:

Assumes accountability for continued accreditation by the National Committee for Quality Assurance (NCQA) and other regulatory organizations (if applicable). Manages the ongoing development, oversight, and implementation of NCQA policies and procedures that guide and support the provision of services, as well as compliance with all regulatory guidelines. Maintains oversight of NCQA credentialing policies governing physicians, advanced practice providers, and other allied health professionals for the OhioHealth Clinically Integrated Network (CIN) and OH-Independent Medical Group. Ensures compliance with legal and regulatory requirements to minimize organizational risk.
Serves as an administrator for the Network Operation Entity in the Credentialing software. This entails detailed knowledge of the database and the rationale behind the data. The Credentialing software administrator will also be responsible for fielding questions from customers and evaluating permission requests for end users for Network Operation. The Manager will support selection and implementation of credentialing software systems/enhancements to automate tasks and improve accuracy. The Manager will also facilitate training for staff to maximize utilization of new technology platforms.
Oversee network management and enrollment function for OH-Independent Medical Group or transferring from a TIN previously in the CIN. The Manager is responsible for ensuring the enrollment function is completed with all CIN and OhioHealth payers including Medicare/Medicaid prior to care site go-live. The Manager plays a critical role in accelerating the transition of these practices to value-based care and creating a high-quality healthcare experience for providers.
Coordinates all activities pertaining to CIN Membership Committee: The Manager is responsible for CIN Medical Director Review, the Provider Network Development Committee (PND), the Credentials Committee and the Peer Review Committee (PRC). This includes preparation and distribution of credentialing documentation, PND, Credentials Committee and PRC agenda/minutes development, distribution, and maintenance as required by NCQA standards. The Manager provides guidance regarding regulatory requirements to the CIN Medical Directors and completes follow-up as requested upon review of applications under review.

40% Leadership:

Provides input into planning and decisions.
Facilitates environment of servant leadership and customer service.
Plans and directs management activities, working and collaborating with other departments including OhioHealth leadership, the Manager of CVO, OhioHealthy, OH-Independent Medical Group administration, legal counsel, and other customers.
Actively participates in Population Health business line, departmental and system activities as needed.
Develops and maintains professional relationships.
Actively collaborates with associates to develop goals and strategies for professional development.
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