This position is responsible for managing the end to end oversight responsibilities for delegated credentialing including but not limited to: ongoing relations, communications and education of the delegated group; oversight audits for compliance with UnitedHealthcare, NCQA, State and Federal credentialing requirements; driving consistent and efficient processes to support the management of all delegated audit activities; problem resolution; defining and recommending action items for the delegated group; evaluating outcomes and providing ongoing feedback to appropriate delegate and internal staff/committees; providing support at Regulatory and Accreditation surveys. Communication, flexibility, credibility, and the ability to interpret accreditation and regulatory requirements and delegated entity policies to assure accurate implementation of processes are the key drivers needed in this role in order to establish and sustain the delegated relationship, learn about their environment and help customers understand United’s delegated credentialing model.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Use pertinent data and facts to identify and solve a range of problems within area of expertise
- Investigate non-standard requests and problems, with some assistance from others
- Work exclusively within a specific knowledge area
- Prioritize and organize own work to meet deadlines
- Provide explanations and information to others on topics within area of expertise
- Effective written and verbal business communications and analytical skills
- Self-motivated and results oriented as well as an ability to promote teamwork and data based decision-making
NCQA Credentialing experience
Background in credentialing delegation oversight or NCQA credentialing accreditation may be considered in lieu of credentialing experience
3+ years’ experience in NCQA credentialing or credentialing delegation oversight
Experience in conflict/problem resolution
Ability to travel up to 25% of the time
PC skills including Excel, Word and Outlook
High School Diploma / GED
Superb organizational and time management skills with a proven ability to manage prioritize multiple tasks and short timelines which involve multiple contributors
Effective written and verbal business communications and analytical skills
Self-motivated and results oriented as well as an ability to promote teamwork and data based decision-making
Continuous quality improvement experience
Experience in reviewing provider records in NDB (credentialing and contracting)
MS Access applications
Ability to work autonomously
Strong conflict management and negotiation skills
Finding and securing the best providers for our growing networks is helping UnitedHealth Group improve the lives of millions. Join us. Learn more about how you can start doing your life's best work.(sm)
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)
*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: Credentialing, Delegated Account, Manager, Telecommute