Senior Manager, Credentialing

Responsible for leading the credentialing, operational compliance, and provider contracting staff and activities. Work closely with management on executing department strategies and meeting division/corporate goals. Provide management oversight in areas of budget, staffing, resource planning, forecasting, and change management.

Responsible for provider networks, including operational regulatory compliance, NCQA Credentialing Accreditation, Credentialing Committee, timely and accurate contract management, timely credentialing of providers and all related credentialing policies and procedures across multiple networks

Provide leadership and coaching to the Provider Network Development team to accomplish business goals and develop the team for future and current roles, including succession planning. Communicate VSP's strategic goals and the impact the teams’ efforts have in achieving the division and organizational goals

Participate in the development of key division initiatives and strategies; lead, support, and implement assigned operational plan objectives. Identify operational and strategic risks, as well as opportunities, that impact network compliance and credentialing and oversee risk tolerance

Partner with Legal and Procurement on developing and reviewing provider and vendor contracts

Lead provider compliance and accreditation efforts, and work cross-functionally to identify, review, and implement new regulations, processes, policies, and procedures, while increasing efficiencies and maintaining internal controls

Direct the team to achieve and maintain service goals; work closely with Legal, business partners, and Regulatory Compliance to ensure provider network meets organizational needs

Collaborate with division leadership, business partners, and professional representatives, to recommend solutions or enhancements to the provider network and doctor experience

Work with Legal to strategize positioning and represent VSP throughout the Dispute Resolution Process outlined in Network Doctor Agreements. Testify as the VSP representative in Peer Review Hearings, Arbitration, and Depositions

Implement and oversee delegated credentialing processes with strategic partners

Manage the day-to-day relationship with credentialing partners and participate as a voting member within the NAVCP Credentialing Committee

Job Specifications

Typically has the following skills or abilities:

Bachelor’s degree in related field or equivalent experience

Minimum of 3 years of management experience with responsibilities for hiring, training, assigning work, and managing performance of direct reports

Minimum of eight years experience in the health care industry or equivalent

Ability to resolve complex issues and to learn, interpret, and apply information in contractual documents, policies, and procedures

Strong organizational, leadership, communication, and interpersonal skills to effectively work with a variety of individuals and groups

Possess a high degree of initiative and coordination to manage multiple complex division projects

Ability to travel as needed

#LI-REMOTE

#LI-VISIONCARE

Compensation range for the role is listed below. Applicable salary ranges may differ across markets. Actual pay will be determined based on experience and other job-related factors permitted by law. As a part of the compensation package, this role may include eligible bonuses and commissions. For more information regarding VSP Vision benefits, please click here. 

Salary Ranges: $90,000.00 - $145,000.00

VSP Vision is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to age, gender, race, color, religion, sex, national origin, gender identity, sexual orientation, disability or protected veteran status.  We maintain a drug-free workplace and perform pre-employment substance abuse testing.

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