Licensing Manager

4 weeks ago

Austin, United States Agile Global Solutions, Inc Full time

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We are looking for a Licensing Manager to join our team.


Licensing Manager

Austin, TX or Roseville, CA

Fulltime Opening


Key Responsibilities:

1. Credentialing Process Management:

• Develop and implement comprehensive credentialing policies and procedures to ensure compliance with accrediting bodies, regulatory agencies, and insurance companies.

• Coordinate the credentialing and re-credentialing process for all healthcare providers, including physicians, nurses, allied health professionals, and administrative staff.

• Ensure timely submission of credentialing applications and documents to relevant organizations and agencies.

2. Credential Verification:

• Verify the education, training, licensure, certifications, and work history of healthcare providers through primary source verification and other appropriate methods.

• Maintain accurate and up-to-date credentialing files for each provider, adhering to strict privacy and confidentiality standards.

3. Licensing Compliance:

• Oversee the licensing process for healthcare providers, ensuring that all necessary licenses and permits are obtained and maintained.

• Stay informed about state licensing requirements and updates, ensuring compliance with applicable laws and regulations.

• Monitor license expirations and renewal deadlines, taking proactive measures to prevent lapses in licensure.

4. Compliance and Accreditation:

• Stay abreast of changes in regulations, standards, and accreditation requirements related to credentialing and licensing.

• Collaborate with regulatory agencies, accrediting bodies, and legal counsel to ensure compliance with credentialing and licensing standards.

• Prepare for and participate in audits and surveys related to credentialing and licensing processes.

5. Relationship Management:

• Serve as the primary liaison for credentialing and licensing inquiries from internal and external stakeholders.

• Foster positive relationships with medical staff, department heads, licensing boards, and external credentialing entities.

• Communicate effectively with healthcare providers regarding credentialing and licensing requirements and updates.

6. Performance Improvement:

• Identify opportunities for process improvement and efficiency enhancement within the credentialing and licensing functions.

• Analyze credentialing and licensing data and metrics to identify trends, patterns, and areas for improvement.

• Develop and implement strategies to address deficiencies and optimize credentialing and licensing outcomes.

Qualifications:

• Bachelor's degree in healthcare administration, business administration, or a related field;

• Certification in healthcare credentialing (e.g., Certified Provider Credentialing Specialist - CPCS, Certified Professional Medical Services Management - CPMSM) preferred.

• Minimum of 5 years of experience in healthcare credentialing and licensing, with at least 3 years in a leadership or supervisory role.

• Thorough understanding of credentialing, delegated credentialing and licensing standards, regulations, and best practices, including those established by organizations such as NCQA, The Joint Commission, and state licensing boards.

• Proficiency in credentialing and licensing software and database management systems.

• Excellent organizational, analytical, and communication skills.

• Strong attention to detail and ability to work independently as well as part of a team.

This job description outlines the primary responsibilities and qualifications for the Credentialing/Licensing Manager position at our medical clinic. The duties may evolve over time based on the needs of the organization and changes in the healthcare landscape.

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