About KeyCare

KeyCare is creating the future of virtual care. Our mission is to expand access to healthcare by connecting virtual care teams, solutions, and data to health systems on one platform.

Position Description

As the Credentialing Manager, you will be responsible on a day-to-day basis for all provider credentialing related tasks, using the Verifiable credentialing platform, ensuring all providers are properly credentialed within our medical group in accordance with NCQA accredited guidelines. The Credentialing Manager will ensure that all credentialing tasks and processes, including but not limited to provider onboarding, credentialing, licensing, and payer enrollment, are properly prioritized and completed as swiftly and effectively as possible to support company operational and growth goals and strategies. This role will assist with customer engagement activities as it relates to provider availability and utilization from time to time.

Responsibilities

• Does all that is necessary\ to ensure that sufficient clinical provider staff resources are credentialed in advance and ready to meet upcoming clinical service needs including direct provider credentialing work.
• Supervises all credentialing team personnel and activities related to provider onboarding, credentialing, licensing, and payer enrollment, provider file maintenance, communications, and delegated credentialing activity
• Ensures the department continually follows NCQA guidelines and continually provides suggestions and feedback as to how to streamline processes and procedures.
• Participate in NCQA survey readiness activities
• Manages customer requirements as they may relate to credentialing and/or delegated credentialing activity
• Manages all personnel functions within the department and conducts necessary employee evaluations and reviews working closely with the management team to ensure anything affecting the performance of the operation is resolved effectively
• Ensures the Credentialing Department maintains appropriate documentation including program descriptions, playbooks, policies, and other reference materials to maintain consistent operations and in compliance with federal, state, and safety regulations
• Creates a positive and productive work environment to attract and retain talent

In this role, you will:

• Collaborate with the KeyCare Inc. management team to plan and execute company strategies.
• Forecast clinical staffing needs and ensure that provider staffing pipeline provides sufficient clinical resources to meet business needs and future growth.
• Manage day-to-day efforts and personnel to achieve clinical staffing objectives
• Stay abreast of regulatory requirements and company compliance policies, ensuring timely staff education
• Other responsibilities as assigned

EXPERIENCE:

• Minimum five (5) years’ progressive provider credentialing management experience
• 3 years managerial experience, including supervision of support staff and management oversight of individuals who are self-directed or organized
• Experience with “Verifiable” credentialing software is a major plus

SKILLS AND ABILITIES:

• Knowledge and understanding of standard credentialing guidelines and procedures related to credentialing and activity related to the maintenance of all provider credentialing and correspondence files
• Knowledge of general aspects of clinical care and clinic operations
• Experience in working with physicians, physician groups and hospital systems
• Knowledge and understanding of all aspects of provider relations
• Must possess above average oral and written communication skills and the ability to independently prioritize duties and assignments
• Must be capable of working under pressure situations and must be capable of adapting to various workloads and assignments
• Enthusiastic and creative manager with the ability to inspire others
• Demonstrated ability to work independently and with a sense of urgency in a dynamic environment

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

• Bachelor’s degree preferred
• Preferred certifications:
• Certified Provider Credentialing Specialist (CPCS)
• The National Committee for Quality Assurance (NCQA)
• Utilization Review Accreditation Commission (URAC)
• The Accreditation Association for Ambulatory Healthcare (AAAHC)

BENEFITS:

Eligible for company benefits:

• Medical
• Vision
• Dental
• Life Insurance
• 401K
• Disability
• Unlimited PTO

Travel Requirements

Travel up to 5%

KeyCare is an Equal Opportunity/Affirmative Action Employer.

We encourage all qualified applicants to apply. KeyCare is committed to its evolution towards a diverse and inclusive workplace. All qualified applicants will receive consideration for employment without regard to race, ethnicity, religion, gender or gender identity, sexual orientation, age, marital status, disability, sex, country of origin, or veteran status.