Manager, Delegated Credentialing at VillageMD

| Houston, TX
Sorry, this job was removed at 7:33 a.m. (CST) on Thursday, November 11, 2021
Find out who's hiring in Nationwide.
See all Project Mgmt jobs in Nationwide
Apply now
By clicking continue you agree to Built In’s Privacy Policy and Terms of Use.

Join VillageMD as a Manager, Delegated Credentialing in Houston, TX

Join the frontlines of today's healthcare transformation

Why VillageMD?

At VillageMD, we're looking for a to help us transform the way primary care is delivered and how patients are served. As a national leader on the forefront of healthcare, we've partnered with many of today's best primary care physicians. We're equipping them with the latest digital tools. Empowering them with proven strategies and support. Inspiring them with better practices and consistent results.

We're creating care that's more accessible. Effective. Efficient. With solutions that are value-based, physician-driven and patient-centered. To accomplish this, we're looking for individuals who share our sense of excellence, are ready to embrace change, and never settle for the status quo. Individuals who have the confidence to lead but the humility to never stop learning.

Could this be you?

Integral to our team, you will leverage your expertise in Medicare Advantage and NCQA to ensure our physicians are credentialed in a compliant and timely manner. You’ll work in collaboration with our national head of Delegated Services to adopt best practice methodologies and collaborate with vendors and third-party administrators to ensure optimal performance. This person will establish short and long-term strategic and operational goals for effective credentialing functions as we transition to a delegated services model, eventually across multiple contracts and geographies. You’ll need to demonstrate the ability to forge meaningful relationships with external partners while successfully navigating diverse stakeholder groups with a passion for building something from the ground up.

How you can make a difference

  • Managing third party relationships, including our credentialing vendor, health plans, and our physician partners, to best support organizational goals
  • Aligning with payor partners to increase VillageMD’s scope of delegated credentialing services
  • Optimizing quality and financial performance by aligning service policies with needs of partner physicians, health plans and members
  • Developing and managing the service budget and achieving all performance metrics and goals
  • Achieving and communicating results through regular management reporting including compliance reporting and timeliness reports
  • Maintaining an understanding of governmental regulatory changes within the industry and local markets that may require updates, modifications or changes to policies or procedures
  • Ensuring compliance with CMS, NCQA and payors’ contractual requirements
  • Overseeing day to day operations for payor enrollment credentialing functions with an interest in building and leading a centralized credentialing function as the organization scales
  • Self-monitoring to ensure protocols are being followed to guarantee timely resolution and completion of payor enrollment with no loss of revenue due to untimely enrollment
  • Retaining a professional working relationship with all payors and providers 
  • Working closely with management across the enterprise and the client(s) to facilitate seamless coordination and timely enrollment of new providers coming into the organization

Skills for success

  • You are highly skilled at influencing others to achieve results and can pivot between a leadership and support role depending on situation and need 
  • You are accomplished at distilling complex, technical information to stakeholders at an operational level to effect change
  • Experience performing under pressure with a strong sense of urgency, attention to detail, and a commitment to doing what you say you will do
  • You are solution-oriented and have a passion for being hands-on in problem-solving and execution
  • You are self-starting and maintain a high sense of urgency and accountability in delivering measurable results in line with agreed upon timeframes

 Experience to drive change

  • Experience with managing 3rd party CVO vendors, experience building and maintaining strong relationships with Payors and experience with Delegation and Compliance Auditing
  • Strong working knowledge of Medicare Advantage based on CMS regulations and guidelines
  • Strong working knowledge of NCQA credentialing requirements
  • Leadership experience within the credentialing department of a health plan or delegated provider entity
  • Demonstrated expertise in state and federal regulatory requirements
  • Working knowledge of payer credentialing rules and regulations
  • Experience with CAQH
  • Extensive knowledge and experience with Medicare provider enrollment applications and processes 
  • Proven ability to identify, leverage, and rapidly rollout initiatives and can successfully lead through technical, political, and cultural barriers to change
  • You have a keen focus on results, and can navigate within ambiguity while maintaining a high-level of humility
  • Bachelor's degree required; with a minimum of 5 years of leadership experience
  • Ability to travel as needed

How you will thrive

In addition to competitive salaries, a 401k program with company match, bonus and a valuable health benefits package, VillageMD offers paid parental leave, pre-tax savings on commuter expenses, and generous paid time off. You work in a highly-collaborative, conscientious, forward-thinking environment that welcomes your experience and enables you to make a significant impact from Day 1.

Most importantly, you make a difference. You see a clear connection between your daily work on VillageMD products and services and the advancement of innovative solutions and improved quality of healthcare for providers and patients.

Our unique VillageMD culture – how inclusion and diversity make the difference

At VillageMD, we see diversity and inclusion as a source of strength in transforming healthcare. We believe building trust and innovation are best achieved through diverse perspectives. To us, acceptance and respect are rooted in an understanding that people do not experience things in the same way, including our healthcare system. Individuals seeking employment at VillageMD are considered without regard to race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. 

Those seeking employment at VillageMD are considered without regard to race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status or disability status.

Explore your future with VillageMD today.



Read Full Job Description
Apply now
By clicking continue you agree to Built In’s Privacy Policy and Terms of Use.

Technology we use

  • Engineering
    • JavaLanguages
    • JavascriptLanguages
    • PythonLanguages
    • RLanguages
    • SqlLanguages
    • SwiftLanguages
    • ReactLibraries
    • FlaskFrameworks
    • Node.jsFrameworks
    • Microsoft SQL ServerDatabases
    • Neo4jDatabases
    • PostgreSQLDatabases
    • RedisDatabases
    • TeradataDatabases

An Insider's view of VillageMD

What's the biggest problem your team is solving?

Aggregating disparate sets into one consumable interface is difficult. We constantly think about how to solve it faster and better while keeping it flexible and scalable.

Mario

Principal Software Engineer

What makes someone successful on your team?

It’s an individual’s willingness to get into the details, fully understand the current path to delivery, and think critically about the problems that face providers today that will make them successful at VillageMD.

Dave

Director, Product Development

What’s the vibe like in the office?

The office vibe is centered on holding our work to high standards while maintaining an environment focused on fun and collaboration. My coworkers and I will often be working on completely unrelated projects, but when we hit a roadblock we step back and ask each other for feedback and help. That’s usually when we find the best solutions.

Emily

Healthcare Informatics Analyst

What are VillageMD Perks + Benefits

VillageMD Benefits Overview

We offer competitive bonus, great benefits, generous PTO, strong parental leave policy, and 401k with a match. We are conveniently located near Metra and L trains, and offer commuter benefits. We offer schedule flexibility and work from home options. And, last but certainly not least: loads of snacks and fresh ground whole bean coffee!

Culture
Volunteer in local community
Partners with Nonprofits
Eat lunch together
Intracompany committees
Daily sync
Team owned deliverables
Team based strategic planning
Group brainstorming sessions
Pair programming
Open office floor plan
Diversity
Dedicated Diversity/Inclusion Staff
Highly diverse management team
Unconscious bias training
Diversity manifesto
Mean gender pay gap below 10%
Diversity Employee Resource Groups
Hiring Practices that Promote Diversity
Health Insurance & Wellness Benefits
Dental Benefits
Vision Benefits
Health Insurance Benefits
Life Insurance
Wellness Programs
Onsite Gym
Mental Health Benefits
Retirement & Stock Options Benefits
401(K)
401(K) Matching
Performance Bonus
Child Care & Parental Leave Benefits
Generous Parental Leave
Flexible Work Schedule
Remote Work Program
Family Medical Leave
Vacation & Time Off Benefits
Generous PTO
Paid Volunteer Time
Paid Holidays
Paid Sick Days
Perks & Discounts
Casual Dress
Commuter Benefits
Company Outings
Stocked Kitchen
Happy Hours
Recreational Clubs
Relocation Assistance
Professional Development Benefits
Job Training & Conferences
Diversity Program
Lunch and learns
Cross functional training encouraged
Promote from within
Customized development tracks
More Jobs at VillageMD127 open jobs
All Jobs
Finance
Data + Analytics
Design + UX
Dev + Engineer
HR + Recruiting
Legal
Marketing
Operations
Project Mgmt
Sales
Data + Analytics
new
Remote
Operations
new
Remote
HR + Recruiting
new
Detroit, MI
Marketing
new
Chicago, IL
Operations
new
Orlando, FL
HR + Recruiting
new
Houston, TX
Data + Analytics
new
Remote
HR + Recruiting
new
Dallas-Fort Worth, TX
Operations
new
Chicago, IL
Operations
new
Indianapolis, IN
Operations
new
San Antonio, TX
Operations
new
Houston, TX
Operations
new
Houston, TX
Operations
new
Atlanta, GA
Operations
new
Houston, TX
Data + Analytics
new
Chicago, IL
Operations
new
San Antonio, TX
Operations
new
Houston, TX
Developer
new
Houston, TX
Operations
new
Phoenix – Mesa – Scottsdale, AZ
Operations
new
Bedford, NH
Developer
new
Remote
HR + Recruiting
new
Chicago, IL
Operations
new
Houston, TX
Data + Analytics
new
Chicago, IL
Developer
new
Chicago, IL
Developer
new
Chicago, IL
Data + Analytics
new
Houston, TX
Developer
new
Chicago, IL
Design + UX
new
Chicago, IL
Operations
new
Houston, TX
Data + Analytics
new
Houston, TX
Design + UX
new
Chicago, IL
Developer
new
Chicago, IL
Operations
new
Chicago, IL
Operations
new
Chicago, IL
Data + Analytics
new
Remote
Operations
new
Houston, TX
Data + Analytics
new
Remote
Operations
new
Chicago, IL
HR + Recruiting
new
Dallas-Fort Worth, TX
Project Mgmt
new
Remote
Operations
new
Orlando, FL
Operations
new
Houston, TX
Operations
new
Houston, TX
Operations
new
Houston, TX
Operations
new
Houston, TX
Operations
new
Houston, TX
Data + Analytics
new
Houston, TX
Finance
new
Chicago, IL
Finance
new
Chicago, IL
Finance
new
Chicago, IL
Developer
new
Remote
Sales
new
Chicago, IL
Developer
new
Chicago, IL
Operations
new
Houston, TX
Operations
new
Dallas-Fort Worth, TX
HR + Recruiting
new
Houston, TX
Operations
new
Houston, TX
Operations
new
Houston, TX
Operations
new
Remote
Data + Analytics
new
Remote
Data + Analytics
new
Remote
Finance
new
Chicago, IL
HR + Recruiting
new
Dallas-Fort Worth, TX
HR + Recruiting
new
Chicago, IL
Data + Analytics
new
Phoenix – Mesa – Scottsdale, AZ
Data + Analytics
new
Houston, TX
Developer
new
Houston, TX
Operations
new
Houston, TX
Operations
new
Atlanta, GA
Marketing
new
Chicago, IL
Operations
new
Salt Lake City, UT
HR + Recruiting
new
Atlanta, GA
Data + Analytics
new
Remote
Developer
new
Chicago, IL
Operations
new
Northfield, NJ
Operations
new
Orlando, FL
Operations
new
Chicago, IL
new
San Antonio, TX
Data + Analytics
new
Remote
HR + Recruiting
new
Dallas-Fort Worth, TX
HR + Recruiting
new
Houston, TX
Data + Analytics
new
Chicago, IL
Developer
new
Remote
Design + UX
new
Remote
Operations
new
Orlando, FL
Operations
new
Salt Lake City, UT
Operations
new
Houston, TX
Data + Analytics
new
Houston, TX
Marketing
new
Chicago, IL
Marketing
new
Chicago, IL
HR + Recruiting
new
Remote
HR + Recruiting
new
Chicago, IL
HR + Recruiting
new
Chicago, IL
Operations
new
Chicago, IL
Developer
new
Remote
HR + Recruiting
new
Atlanta, GA
HR + Recruiting
new
Remote
Design + UX
new
Remote
Operations
new
Orlando, FL
Operations
new
Indianapolis, IN
Apply now
By clicking continue you agree to Built In’s Privacy Policy and Terms of Use.
Save jobView VillageMD's full profileSee more VillageMD jobs