Credentialing Manager - Southeast Florida
UnitedHealth Group - Coral Gables, FL

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What makes your Compliance career greater with UnitedHealth Group? Growth opportunities with the potential to impact the health care system ensure it will always be challenging and exciting.


To assist the Director of Credentialing in maintaining departmental functions compliant with rules set by government, accrediting agencies and the organization itself.


Assists the Director of Credentialing Services in managing the Credentialing Program for the organization, including development of short and long-term goals. ¨
Assists the Director of Credentialing Services in creating policies and procedures meeting the goals of the organization and the guidelines established by major accrediting bodies, government agencies, and other entities, as required. ¨
Assists in assuring adequate staffing, training, orientation, equipment and space. ¨
Controls expenses to ensure conformance with approved budged. ¨
Directs workload to ensure consistency, effectiveness and efficiency. ¨
Implements quality assurance mechanisms to ensure compliance with established guidelines and regulations. ¨
Follows current credentialing and recredentialing policies and procedures. ¨
Audits 10% of credentialing and recredentialing files prior to Credentialing Committee’s review for trained staff, 100% for new staff. Returns incomplete files or files with errors and re-audits to ensure files meet 100% compliance with the credentialing program. ¨
Audits credentialing database for accuracy and completeness, percentage of database entries to be audited to be determined based on error ratio. ¨
Tracks applications in-process. ¨
Adheres to the quality assurance methods implemented by the department and/or the organization. ¨
Monitors provider sanctions, limitations, restrictions and exclusions. ¨
Effectively communicates with physicians and their office staff, monitoring agencies, hospitals and other related entities. ¨
Keeps abreast of new software applications and changes to these applications, as applicable to credentialing functions. ¨
Accurately records minutes for the Credentialing Committee. ¨
Follows confidentiality rules established by the department and/or the organization. ¨
Consistently meets deadlines. ¨
Produces tangible, positive impact in the Credentialing Department and the entire organization. ¨
Attends meeting as required. ¨
Assists the Director of Credentialing in the execution and compliance of the credentialing program. ¨
Works closely with the medical staff, administration, and committees in an effort to trouble-shoot problems and gather input for improvement. ¨
Analyses and recommends changes to credentialing policies and procedures on an on-going basis to conform to internal and external changes. ¨
Assures for excellent customer service in the Credentialing Department. ¨
Assists in the management of employee selection, counseling, evaluation, disciplinary actions and termination according to the policies of the organization. ¨
Acquires and maintains extensive knowledge and serves as a consultant on issues related to rules and regulations, accreditation guidelines and quality improvement systems, as they relate to credentialing. ¨
Performs other job-related duties as assigned.

The above statement reflects the general duties considered necessary to describe the principal functions of the job identified and shall not be considered as a detailed description of all work requirements inherent to the position.


AA or AS degree, or an equivalent combination of training and experience in health services administration. ¨
Minimum of 4 years experience in a Management or Supervisory role. ¨
Ability to lead a team of employees. ¨
CPMSM and/or CPCS preferred. ¨
Expertise in credentialing guidelines set by CMS, AHCA and major accrediting entities. ¨
Minimum typing skills of 40 wpm. ¨
Expertise in MS Word, Excel, Access and personal computers. ¨
Knowledge of general office equipment and office systems. ¨
Excellent decision making abilities and customer service skills. ¨
Excellent verbal and written communication skills in the English language. ¨
Excellent analytical skills. ¨
Ability to work both, independently and as a team.

Organized and detail oriented.

UnitedHealthcare Medicare & Retirement is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.

Imagine joining a group of professionals and clinicians who are working to improve health care for people over 50. Consider the influence you can have on the quality of care for millions of people. Now, enhance that success with enthusiasm you can really feel.

That's how it is at UnitedHealthcare Medicare & Retirement. Everyday, we're collaborating to improve the health and well being of the fastest growing segment of our nation's population. And we're doing it with an intense amount of dedication.

Here, you will discover a culture that grows through challenge. That evolves by being flexible. That succeeds by staying true to our mission to make health care work effectively and efficiently for seniors. Put your best to work for us, and discover extraordinary opportunities for growth.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

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