Manager, Managed Care

Manager, Managed Care

Practice Operations Management oversees the business and administrative operations of a medical practice. Managed Care oversees the interactions that take place between payer and provider(s) to ensure optimal reimbursement including managed care contracting, enrollment, credentialing, and any other activity as it relates to payer interaction. The position is responsible for managing the credentialing team and ensuring an active credentialing status with all contracted payors for all Centers, Nurse Practitioners and employed physicians. The position is also responsible for ensuring that all licensure is updated and active for all the markets, clinicians and facilities.

Essential Functions :

• Responsible for documenting and tracking all credentialing, re-credentialing, provider enrollment, and hospital privileging activities within the credentialing software environment.
• Supervises, plans, directs, coordinates, and evaluates the product of team members.
• Assists new providers with obtaining required clinical licenses and coordinates the full cycle onboarding and enrollment into Medicaid, Medicare, and the commercial insurance plans.
• Establish policies, procedures, toolkits, and best practices necessary for successful provider onboarding, including established timeframes, required documentation, and checklists.
• Maintain and monitor all licenses and certifications in the database to ensure compliance within all markets.
• Coordination of provider enrollment activities (including initial enrollments or re-credentialing) for all Centers, employed physicians, and nurse practitioners.
• Ensure all facility and practitioner licenses and certifications are accurate and in good standing at all times including renewing facility license and permits.
• Complete all forms and supporting documents required to obtain hospital privileges for physicians, as necessary including renewal applications.
• Ensure that all processing and reporting deadlines are consistently achieved.
• Conducts weekly conference calls with the Clinical Operations teams to provide status updates of onboarding activities.
• Meets regularly with the Director of Managed Care Contracting and other team members to provide updates on progress and status of credentialing and enrollment matters.
• Participates in special projects, including acquisitions and de novo projects; opening new locations; adding new service lines, and closing facilities.
• Assists the Revenue Cycle Team with claims denial research; finding out whether we are in-network with specific products, and other miscellaneous billing and collections issues.
• Assists the Director of Managed Care with special contracts projects, including the loading of executed contracts into the iContracts database.
• Performs any other functions as required by management.
• Regular attendance and punctuality is required.

Qualifications :

What is expected of you and others at this level :

Anticipated hourly range : 105,100K - 165,100K (Annual) Bonus eligible : No

Benefits : Cardinal Health offers a wide variety of benefits and programs to support health and well-being.

Application window anticipated to close : 12 / 2 / 25 if interested in opportunity, please submit application as soon as possible.

The hourly range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity. Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply.

Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day.

Cardinal Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity / expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law.