Assistant Director

York, New York

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The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.

Provide leadership and oversee the overall operations, processes and resources for the Credentialing and Provider Data Management (PDM) Team within the Network, Planning and Operations (NPO) department. Ensure the Teams have established workflows for all aspects of the Credentialing and PDM end to end lifecycle. Oversee monitoring of all provider data auditing and implements continuous operational improvements in a proactive manner.

  • 5-7 years of experience in a managed care setting.
  • Knowledge of CMS (Medicare, Medicaid) and state and federal regulations (NYSDOH, DFS, OIG, OMIG, etc.).
  • Established track record in health care, specifically in Credentialing and PDM with career progression.
  • Experience using credentialing software (i.e CACTUS) and direct hands on CAQH experience.
  • Strong Knowledge of Credentialing requirements (CMS and NYDOH)
  • Strong Knowledge of Provider Data requirements (CMS and NYDOH)
  • Experience managing the systems used to support the operation: Healthrules Payor, CACTUS (Symplr), Tract Manager (Symplr), Quest Analytics.
  • Knowledge of NCQA, CMS, JCAHO and/or quality requirements. CPCS or CPMSM certification preferred.
Date Posted: 12 September 2022
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