CPCS / CPMSM Managed Care Senior Project Manager (Remote)

4 weeks ago

Chesterfield, United States Mercy Full time

We're a Little Different

Our mission is clear. We bring to life a healing ministry through our compassionate care and exceptional service.

At Mercy, we believe in careers that match the unique gifts of unique individuals – careers that not only make the most of your skills and talents, but also your heart. Join us and discover why Modern Healthcare Magazine named us in its “Top 100 Places to Work.”


Overview: CPCS or CPMSM Managed Care Senior Project Manager (Remote)

The Managed Care Senior Project Manager supports the ongoing operational strategies of the Managed Care department. In partnership with functional leaders, the Senior Project Manager is responsible for driving business readiness activities across multiple teams to ensure timely, high-quality implementation of new products, product expansions or major initiatives within Managed Care. This role will include being responsible for managing projects and implementations as assigned in order to maximize the efficiency of the Managed Care department. This involves collaboration with departments across the Ministry and escalating issues and concerns accordingly. Performs duties and responsibilities in a manner consistent with our mission, values, and Mercy Service Standards.


Qualifications:

  • Experience: 5+ years' experience in health care, preferably in managed care, can be either provider or health plan. 2-5 years Program and/or project management experience
  • Required Education: Bachelor's degree.Master's/graduate degree preferred

  • Certifications:

    • Certified Provider Credentialing Specialist (CPCS): Preferred or within three years on the job.
    • Certified Provider Medical Staff Management (CPMSM): Preferred or within five years on the job

  • Core Functions:

    • Oversee outreach to primary sources for practitioners' information, ensuring staff are accurately obtaining and evaluating information from primary sources.
    • Determine applicant's initial eligibility for membership/participation based on approved criteria.
    • Support NCQA accreditation process and maintenance of accreditation once approved.
    • Oversees delegation process.
    • Oversee the department's participation in surveys and audits of regulatory and accreditation agencies or organizations.
    • Oversee the monitoring and reporting of sanctions and complaints for all practitioners/providers to inform and recommend action by organizational leadership.
    • Advanced understanding of state, federal, and regulatory standards. Update applicable governing documents (policies and procedures) that support and direct organizational practices and ensure compliance.
    • Audit, assess, procure, implement, effectively utilize and maintain practitioner/provider credentialing processes and information systems (e.g., files, reports, minutes, databases) by analyzing the needs and resources of health plans/credentialing.
    • Foster a team-dynamic and cohesive, collaborative department with an entirely remote workforce.

  • Other:

    • Proficient in Microsoft Office Products
    • Proficient with Symplr or comparable credentialing systems is preferred.

We Offer Great Benefits:


Day-one comprehensive health, vision and dental coverage, PTO, tuition reimbursement and employer-matched retirement funds are just a few of the great benefits offered to eligible co-workers, including those working 32 hours or more per pay period

We're bringing to life a healing ministry through compassionate care.


At Mercy, our supportive community will be behind you every step of your day, especially the tough ones. You will have opportunities to pioneer new models of care and transform the health care experience through advanced technology and innovative procedures. We're expanding to help our communities grow. Join us and be a part of it all.


What Makes You a Good Match for Mercy?


Compassion and professionalism go hand-in-hand with us. Having a positive outlook and a strong sense of advocacy is in perfect step with our mission and vision. We're also collaborative and unafraid to do a little extra to deliver excellent care – that's just part of our commitment. If that sounds like a good fit for you, we encourage you to apply.

EEO/AA/Minorities/Females/Disabled/Veterans

  • Senior Project Manager

    2 weeks ago

    Chesterfield, United States Olsson Full time

    Company Description We are Olsson, a team-based, purpose-driven engineering and design firm. Our solutions improve communities and our people make it possible. Our most meaningful asset is our people, and we are dedicated to providing an environment where they can continue to learn, grow, and thrive. Our entrepreneurial spirit is what has allowed us...

  • Senior Project Manager

    1 month ago

    Chesterfield, United States Brinkmann Constructors Full time

    Overview At Brinkmann, our purpose is people and our passion is building.  Is creativity at your core to provide the best right answer? Are you managing large construction projects as if they are your own? Are you always prepared to build success with honesty and accountability? Do you stand up and speak out on behalf of your new and repeat...

  • Senior Project Manager

    4 weeks ago

    Chesterfield, United States Brinkmann Constructors Full time

    Overview At Brinkmann, our purpose is people and our passion is building.  Is creativity at your core to provide the best right answer? Are you managing large construction projects as if they are your own? Are you always prepared to build success with honesty and accountability? Do you stand up and speak out on behalf of your new and repeat...

  • Project Manager

    1 month ago

    Chesterfield, United States Nimble Solutions Full time

    Job DescriptionJob DescriptionDescription:Why you’ll want to work at nimble! Looking for a seat at the table? This is a great opportunity to join a well-established and market-leading brand serving a high growth end market while gaining valuable experience working closely with Executive leadership. As an organization, we are in high growth mode through...

  • Project Manager

    4 weeks ago

    Chesterfield, United States Nimble Solutions Full time

    Job DescriptionJob DescriptionDescription:Why you’ll want to work at nimble! Looking for a seat at the table? This is a great opportunity to join a well-established and market-leading brand serving a high growth end market while gaining valuable experience working closely with Executive leadership. As an organization, we are in high growth mode through...

  • Senior Business Analyst

    4 weeks ago

    Chesterfield, United States S2 Tech Full time

    Job Details Description Senior Business Analyst - CMS Certification Location: Remote About Us Known for “Delighting the Client” through performance, innovation, and an employee-centric culture, S2Tech is a fast-growing IT consulting company serving clients in over a quarter of the United States. We are widely recognized as a leading provider of both...

  • Project Manager

    4 weeks ago

    Chesterfield, United States Olsson Full time

    Job DescriptionJob DescriptionCompany DescriptionWe are Olsson, a team-based, purpose-driven engineering and design firm. Our solutions improve communities and our people make it possible.Our most meaningful asset is our people, and we are dedicated to providing an environment where they can continue to learn, grow, and thrive. Our entrepreneurial spirit is...

  • Project Manager 4

    2 months ago

    North Chesterfield, United States GS1 Consulting Full time

    The Virginia Department of Police (VSP) Information Security Office is seeking a senior IT Technical Project Manager to manage and deliver complex IT project(s) with multiple teams and work streams coordinated to an aggressive delivery schedule. The project manager is responsible for the outcome of the assigned projects. The project manager leads the team...

  • Project Manager 4

    2 days ago

    North Chesterfield, United States GS1 Consulting Full time

    The Virginia Department of Police (VSP) Information Security Office is seeking a senior IT Technical Project Manager to manage and deliver complex IT project(s) with multiple teams and work streams coordinated to an aggressive delivery schedule. The project manager is responsible for the outcome of the assigned projects. The project manager leads the team...

  • Project Manager

    2 weeks ago

    Chesterfield, United States Mesa Logistics Group Full time

    Job DescriptionJob DescriptionJob Summary:We are seeking a Project Manager with experience in managing projects in the design, hospitality, and retail space. The Project Manager will be responsible for inventory management and consolidation, planning, executing, and evaluating projects according to predetermined timelines and budgets. Qualifications:-...

  • Director - Managed Care Network Operations - REMOTE

    4 weeks ago

    Chesterfield, United States Mercy Full time

    Overview: Were a Little Different Our mission is clear. We bring to life a healing ministry through our compassionate care and exceptional service. At Mercy, we believe in careers that match the unique gifts of unique individuals careers that not only make the most of your skills and talents, but also your heart. Join us and discover why Modern Healthcare...

  • Senior Cognos Developer

    4 weeks ago

    Chesterfield, United States S2 Tech Full time

    Senior Cognos DeveloperLocation: RemoteAbout Us: Known for “Delighting the Client” through performance, innovation, and an employee-centric culture, S2Tech is a fast-growing IT consulting company serving clients in over a quarter of the United States. We are widely recognized as a leading provider of both technical and business services in support of...

  • Senior Cognos Developer

    4 weeks ago

    Chesterfield, United States S2 Tech Full time

    Senior Cognos DeveloperLocation: RemoteAbout Us: Known for “Delighting the Client” through performance, innovation, and an employee-centric culture, S2Tech is a fast-growing IT consulting company serving clients in over a quarter of the United States. We are widely recognized as a leading provider of both technical and business services in support of...

  • Director - Managed Care Network Operations - REMOTE

    2 weeks ago

    Chesterfield, Missouri, United States Mercy Full time

    Overview:Were a Little DifferentOur mission is clear. We bring to life a healing ministry through our compassionate care and exceptional service. At Mercy, we believe in careers that match the unique gifts of unique individuals careers that not only make the most of your skills and talents, but also your heart. Join us and discover why Modern Healthcare...

  • Senior Test/QA Analyst

    1 month ago

    Chesterfield, United States S2 Tech Full time

    Senior Test/QA Analyst - MedicaidLocation: RemoteAbout Us: Known for “Delighting the Client” through performance, innovation and an employee-centric culture, S2Tech is a fast-growing IT consulting company serving clients in over a quarter of the United States. We are widely recognized as a leading provider of both technical and business services in...

  • Senior Test/QA Analyst

    4 weeks ago

    Chesterfield, United States S2 Tech Full time

    Senior Test/QA Analyst - MedicaidLocation: RemoteAbout Us: Known for “Delighting the Client” through performance, innovation and an employee-centric culture, S2Tech is a fast-growing IT consulting company serving clients in over a quarter of the United States. We are widely recognized as a leading provider of both technical and business services in...

  • Project Manager

    1 month ago

    Chesterfield, United States Olsson Full time

    Job DescriptionJob DescriptionCompany DescriptionWe are Olsson, a team-based, purpose-driven engineering and design firm. Our solutions improve communities and our people make it possible.Our most meaningful asset is our people, and we are dedicated to providing an environment where they can continue to learn, grow, and thrive. Our entrepreneurial spirit is...

  • Project Manager

    4 weeks ago

    Chesterfield, United States Olsson Full time

    Job DescriptionJob DescriptionCompany DescriptionWe are Olsson, a team-based, purpose-driven engineering and design firm. Our solutions improve communities and our people make it possible.Our most meaningful asset is our people, and we are dedicated to providing an environment where they can continue to learn, grow, and thrive. Our entrepreneurial spirit is...

  • Senior Test/QA Analyst

    1 month ago

    Chesterfield, United States S2Tech Full time

    Senior Test/QA Analyst - MedicaidLocation: RemoteAbout Us:Known for "Delighting the Client" through performance, innovation and an employee-centric culture, S2Tech is a fast-growing IT consulting company serving clients in over a quarter of the United States. We are widely recognized as a leading provider of both technical and business services in support of...

  • Senior Test/QA Analyst

    4 weeks ago

    Chesterfield, United States S2Tech Full time

    Senior Test/QA Analyst - MedicaidLocation: RemoteAbout Us:Known for "Delighting the Client" through performance, innovation and an employee-centric culture, S2Tech is a fast-growing IT consulting company serving clients in over a quarter of the United States. We are widely recognized as a leading provider of both technical and business services in support of...