Job Information
Evolent Health Manager, Credentialing Operations in Nashville, Tennessee
Your Future Evolves Here
Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.
Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business.
Join Evolent for the mission. Stay for the culture.
What You’ll Be Doing:
The Manager, Credentialing Operations will be a dynamic role that will work directly with our partners, focus on coordinating, monitoring, trending, and supporting our day-to-day credentialing operations. This position reports to the Associate Director, Credentialing Operations.
Collaboration Opportunities:
The Manager, Credentialing Operations collaborates with Provider Data Management (PDM), Market Operations, Shared Service team, and our external business partners to monitor operations, resolve service barriers, develop solutions to improve effectiveness, and identify continuous improvement initiatives to increase service and operational level agreements.
What You Will Be Doing:
Plan, organize, direct, and effectively manage the responsibility for overseeing the day-to-day operations, hiring, team building activities, training, supervision of department staff, corrective action process, mentoring, coaching employees, and completing performance reviews.
Accountable for establishing, contributing, and implementation of standards applicable to provider staff relating to credentialing and administrative functions in compliance with credentialing, regulatory and accreditation requirements.
Prepare key credentialing operational reports for internal and external partners that drive business decisions and impact strategic planning.
Maintain comprehensive knowledge of both state and federal statutory requirements to ensure that all legal, licensure and accreditation standards, due dates and deadlines are met.
Assure credentialing activities are integrated and administered by the department in partnership with partner Committees, including Credentials and Quality Improvement Committees (QIC).
Work with Senior leadership to support certification and accreditation processes with National Committee for Quality Assurance (NCQA)
Serve as an expert in the administration and maintenance of credentialing and provider data management systems, including the Council for Affordable Quality Healthcare (CAQH), Credentialing System, sPayer, Symplr and proprietary claim systems.
Qualifications - Required and Preferred:
High school graduation or completion of General Equivalency Degree/Diploma (GED) – Required .
Bachelor’s degree – Preferred.
Three (3) to five (5) years of credentialing and/or provider enrollment leadership experience with physicians, Advance Practice Clinicians (APCs), behavioral health, and/or allied providers, in a fast-paced health care environment (hospital, provider group, health plan) – Required.
Certified Provider Credentialing Specialist (CPCS) certification - Preferred
Experience working within a health plan, managed care organization, provider operated healthcare environment or Third-Party Administrator (TPA)/Business Process Outsourcing (BPO) - Required
Extensive knowledge of computers and related software applications, such as Word, PowerPoint, Excel, Project - Required
Prior supervisory or management experience – Required.
Experience with Medicare Advantage and Medicaid plans - Preferred.
Experience working with senior leadership to support certification and accreditation processes with National Committee for Quality Assurance (NCQA)- Preferred.
Technical Requirements:
We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.
Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status. If you need reasonable accommodation to access the information provided on this website, please contact recruiting@evolent.com for further assistance.
The expected base salary/wage range for this position is $65,000 up to 80,000. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts.
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