Credentialing Supervisor

4 weeks ago

Fairfield, California, United States Partnership HealthPlan of California Full time
Job Summary

We are seeking a highly skilled Credentialing Supervisor to join our team at Partnership HealthPlan of California. The successful candidate will be responsible for overseeing the day-to-day operations of our credentialing functions, providing leadership and support to our Provider Relations Credentialing Specialist staff, and ensuring the highest level of accuracy and timeliness in our credentialing processes.

Key Responsibilities
  • Supervise the daily functions of the PR Credentialing staff, processing credentialing and re-credentialing applications for medical providers and organizations according to NCQA standards.
  • Provide leadership, direction, training, and support to staff, ensuring they have the necessary skills and knowledge to perform their duties effectively.
  • Monitor staff productivity, accuracy, and service delivery, using performance standards to evaluate their performance.
  • Evaluate staff needs and conduct or arrange training to ensure they have the necessary skills to perform their duties.
  • Monitor inventory control reports weekly and adjust staff priorities as needed.
  • Produce bi-weekly inventory and aging reports.
  • Support staff development by identifying applicable training opportunities and training staff on new and challenging duties.
  • Conduct annual performance evaluations.
  • Monitor ACD phone usage and issue daily/weekly reports.
  • Interview and participate in the selection of PR staff who will directly report to the Supervisor.
  • Responsible for cross-training, ensuring at least two staff can perform each function.
  • Participate in PHC audits, internal and external, preparing documentation and participating in special projects and assignments.
  • Ensure timelines and due dates are met.
  • Attend PHC Credentialing Committee, overseeing the quality of materials presented, ensuring agendas, supporting documents, and minutes are prepared timely and accurately.
  • Responsible for credentialing delegation oversight, ensuring delegated entities submit required documents on schedule and follow-up as required.
  • Oversee timely audits of delegated credentialing activities.
  • Ensure Credentialing policies are updated and in compliance with DHCS and NCQA requirements.
  • Ensure desktop procedures are up-to-date.
  • Promote a positive attitude, teamwork, and fun in the workplace.
Qualifications
  • Bachelor's degree in Healthcare, Business, or related field, and minimum three (3) years of experience in healthcare, credentialing, or provider relations, or equivalent combination of education and experience.
  • Previous supervisory experience a plus.
  • Knowledge of medical providers and credentialing requirements.
Performance Based Competencies
  • Excellent oral and written communication skills.
  • Excellent organization skills with the ability to prioritize assignments, maintain accurate records, and meet deadlines.
  • Ability to use good judgment in making decisions within scope of authority and handle sensitive issues with tact and diplomacy.
Work Environment And Physical Demands
  • Ability to use a computer keyboard.
  • More than 30% of work time is spent in front of a computer monitor.
  • When required, ability to move, carry, or lift objects of varying size, weighing up to 35 lbs.

  • Credentialing Supervisor

    3 weeks ago

    Fairfield, California, United States Partnership HealthPlan of California Full time

    Job SummaryThe Credentialing Supervisor is responsible for overseeing the day-to-day operations of Partnership HealthPlan of California's (PHC) credentialing functions. This includes providing leadership, support, training, and direction to the Provider Relations Credentialing Specialist staff. The successful candidate will ensure the highest level of...

  • Credentialing Supervisor

    3 weeks ago

    Fairfield, California, United States Partnership HealthPlan of California Full time

    Job SummaryAs a Credentialing Supervisor at Partnership HealthPlan of California, you will oversee the day-to-day operations of our credentialing functions. You will provide leadership, support, training, and direction to the Provider Relations Credentialing Specialist staff. Your goal will be to ensure the highest level of accuracy and timeliness of...

  • Special Education- Speech and Language Pathologist Pool

    5 months ago

    Fairfield, United States Fairfield-Suisun Unified Full time

    About the Employer A premier learning community that empowers each student to thrive in an ever-changing world. Job Description / Essential Elements: Fairfield-Suisun Unified School District TEACHER: DESIGNATED INSTRUCTIONAL SERVICE JOB DESCRIPTION PRIMARY FUNCTION: To assist in the diagnosis of and to provide specialist instructional service to students...

  • Registered Nurse

    1 month ago

    Fairfield, United States Hartford Healthcare Full time

    Description Job Schedule: Per Diem Standard Hours: 1 Job Shift: Shift 1 Shift Details: As needed per diem for Day, Evening, and Night shifts. Work where every moment matters. Every day, over 30,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here.  We invite you to become part...

  • Registered Nurse

    1 month ago

    Fairfield, United States Hartford Healthcare Full time

    Description Job Schedule: Full Time Standard Hours: 40 Job Shift: Shift 3 Shift Details: 40 hours per week night shift RN, 11:00pm-7:30am. Required to work every other weekend Work where every moment matters. Every day, over 30,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters...

  • LPN Medication Care Manager

    2 weeks ago

    Fairfield, New Jersey, United States Sunrise Senior Living Full time

    Sunrise Senior Living OpportunitiesSunrise Senior Living is a leading provider of senior care services, committed to championing quality of life for all seniors. We are seeking an experienced LPN to join our team as a Medication Care Manager.Job Summary:The LPN Medication Care Manager is responsible for providing high-quality care and services to our...

  • PRN Cardiac Sonographer-Fairfield Hospital

    3 weeks ago

    Fairfield, United States Mercy Health Full time

    Everyone who works with Mercy Health is united under one purpose: to help our patients be well in mind, body and spirit. This drive, along with our history of faith, is a powerful combination. It gives us a shared calling to work toward every day. Join our exceptional team and help us continue to provide the highest quality of health care possible to our...

  • LPN Med Care Manager

    3 weeks ago

    Fairfield, United States Sunrise Senior Living Full time

    Sunrise Senior Living was again certified as a Great Place to Work® by Activated Insights. This is the 7th time Sunrise has received this top culture and workplace designation, highlighting the special place Sunrise is to be a part of. COMMUNITY NAME Sunrise of West Essex Job ID 2024-218148 JOB OVERVIEW The LPN Medication Care Manager is responsible...

  • Truck Lead

    3 months ago

    Fairfield, United States Colony Grill Full time

    Voted a Top Workplace and Top Pizza nationally, Colony Grill is looking to expand its pizza truck fleet….Voted one of the top food trucks in the Fairfield County/NY metro area, the Colony Grill “Hot Oil Rig” is a custom-built, fully self-contained pizza truck that delivers our signature thin-crust bar-style pizzas and Colony’s exceptional hospitality...

  • LPN Med Care Manager

    2 months ago

    Fairfield, United States Sunrise Senior Living Full time

    OverviewThe LPN Medication Care Manager is responsible for providing the highest degree of quality care and services by administering medication and treatments in a safe organized manner. Responsibilities include but are not limited to administration of medications, documentation of medication administration, conducting SHUs, and providing resident care...

  • LPN Med Care Manager

    1 month ago

    Fairfield, United States Sunrise Senior Living Full time

    OverviewThe LPN Medication Care Manager is responsible for providing the highest degree of quality care and services by administering medication and treatments in a safe organized manner. Responsibilities include but are not limited to administration of medications, documentation of medication administration, conducting SHUs, and providing resident care...

  • LPN Med Care Manager

    1 month ago

    Fairfield, United States Sunrise Senior Living Full time

    OverviewThe LPN Medication Care Manager is responsible for providing the highest degree of quality care and services by administering medication and treatments in a safe organized manner. Responsibilities include but are not limited to administration of medications, documentation of medication administration, conducting SHUs, and providing resident care...

  • LPN Med Care Manager

    2 months ago

    Fairfield, United States Sunrise Senior Living Full time

    OverviewThe LPN Medication Care Manager is responsible for providing the highest degree of quality care and services by administering medication and treatments in a safe organized manner. Responsibilities include but are not limited to administration of medications, documentation of medication administration, conducting SHUs, and providing resident care...

  • LPN Med Care Manager

    3 weeks ago

    Fairfield, United States Sunrise Senior Living Full time

    OverviewThe LPN Medication Care Manager is responsible for providing the highest degree of quality care and services by administering medication and treatments in a safe organized manner. Responsibilities include but are not limited to administration of medications, documentation of medication administration, conducting SHUs, and providing resident care...

  • LPN Med Care Manager

    4 weeks ago

    Fairfield, United States Sunrise Senior Living Full time

    OverviewThe LPN Medication Care Manager is responsible for providing the highest degree of quality care and services by administering medication and treatments in a safe organized manner. Responsibilities include but are not limited to administration of medications, documentation of medication administration, conducting SHUs, and providing resident care...

  • RRT- Registered Respiratory Therapist- Fairfield

    4 weeks ago

    Fairfield, United States Bon Secours Mercy Health Full time

    At Bon Secours Mercy Health, we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. RRTs could receive a sign-on bonus up to $20,000 Mercy Health As a faith-based and patient-focused organization, Mercy Health exists to...

  • Respiratory Care Professional- Fairfield Hospital

    4 weeks ago

    Fairfield, United States Bon Secours Mercy Health Full time

    At Bon Secours Mercy Health, we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. Summary of Primary Function/General Purpose of Position The Respiratory Care Practitioner II is responsible for providing respiratory care...

  • RRT- Registered Respiratory Therapist- Fairfield

    3 weeks ago

    Fairfield, United States Mercy Health Full time

    Everyone who works with Mercy Health is united under one purpose: to help our patients be well in mind, body and spirit. This drive, along with our history of faith, is a powerful combination. It gives us a shared calling to work toward every day. Join our exceptional team and help us continue to provide the highest quality of health care possible to our...

  • Respiratory Care Professional

    2 hours ago

    Fairfield, United States Bon Secours Mercy Health Full time

    At Bon Secours Mercy Health, we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. Respiratory Care Practitioner II/Flat Rate/WEO (harmonized) – Fairfield Hospital Job Summary: The Respiratory Care Practitioner II is...

  • LPN Med Care Manager

    1 month ago

    Fairfield, NJ, United States Sunrise Senior Living Full time

    OverviewThe LPN Medication Care Manager is responsible for providing the highest degree of quality care and services by administering medication and treatments in a safe organized manner. Responsibilities include but are not limited to administration of medications, documentation of medication administration, conducting SHUs, and providing resident care...

  • LPN Med Care Manager

    4 weeks ago

    Fairfield, Cumberland County, NJ, United States Sunrise Senior Living Full time

    Overview The LPN Medication Care Manager is responsible for providing the highest degree of quality care and services by administering medication and treatments in a safe organized manner. Responsibilities include but are not limited to administration of medications, documentation of medication administration, conducting SHUs, and providing resident care...

  • LPN Med Care Manager

    3 weeks ago

    Fairfield, NJ, United States Sunrise Senior Living Full time

    Sunrise Senior Living was again certified as a Great Place to Work by Activated Insights. This is the 7th time Sunrise has received this top culture and workplace designation, highlighting the special place Sunrise is to be a part of. COMMUNITY NAME Sunrise of West Essex Job ID 48 JOB OVERVIEW The LPN Medication Care Manager is responsible for...