Credentialing Manager
University HealthCare Alliance - Richmond, CA

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University Healthcare Alliance (UHA) has an exciting opportunity for a Credentialing Manager. This role is responsible for building and overseeing a team that manages all aspects and operations of provider credentialing and roster management for UHA and its partnering entities, including providers participating in UHA's Foundation Medical Groups and providers contracted with UHA affiliated IPAs. The team is responsible for maintaining an accurate roster of providers and their affiliation with the organization, completing primary source verification of provider applicants, completing initial credentialing and re-credentialing, facilitating and documenting all necessary peer review meetings, and serving as the escalation for credentialing related issues and matters. The role is responsible for maintaining compliance in accordance with UHA, state, federal, and regulatory agency standards.

Desired Skills & Experience
    • CPMSM or CPCS certification or demonstrated progress towards achieving certification.

    • Preferred active member of the National Associate Medical Staff Services, California Association Medical Staff Services or other professional organization related to credentialing verification.

    • Demonstrated experience in the development and management of provider credentialing and medical group policies and standards.

    • Knowledge of California Industry Collaborative Effort (ICE) and NCQA Credentialing Guidelines.

    • Proven ability to establish and maintain effective internal and external working relationships and as an effective, contributing team leader.

    • Excellent verbal and written communication skills, as well as the ability to document thoroughly and maintaining professional meeting minutes.

    • Strong computer skills, including competency in Microsoft Office (Word, Excel, and PowerPoint); experience in use of the Web for research.

    • Strong communication, collaboration, project management and analytical skills are essential.

    • Demonstrated ability to prioritize multiple projects and implementing new programs/projects with a focus on continuous process improvement.

    • Must meet all applicable state requirements for education, training, credentialing, competency, standards of practice, certification and licensure in the state

    • Bachelor's degree required

    • 5 or more years of experience performing physician credentialing at a Medical Group, Hospital, or Health Plan

    • 3 or more years of experience directly supervising staff

To Apply We invite you to send your resume and cover letter to: affinitymdhr@affinitymd.com . Please include "Credentialing Manager" in the subject line.

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