Who We Are

　　Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

　　We enjoy the important work we do every day in service to our members, partners, colleagues and communities. To learn more about who we are at Point32Health, click here (https://youtu.be/S5I_HgoecJQ) .

　　Job Summary

　　Reporting to the Director, Provider Operations, The Manager, Credentialing provides leadership, oversight, and direction to the Credentialing team. This role that balances strategy and operations will be responsible for the general direction of the Point32Health enterprise credentialing program that includes compliance with all state, federal, and accrediting agency requirements.

　　The Manager, Credentialing should possess a strong understanding of Credentialing, Recredentialing, and Delegation. Responsible for the leadership of the credentialing team who are responsible for ensuring that all applicable contracted providers are credentialed according to the defined process, and the development of goals, metrics, and KPIs for the team to monitor the Credentialing Programs success.

　　The Manager works with direct reports to ensure timely assembly of necessary quality data, works with the Compliance areas to support obtaining documentation for preparation for the Quality-of-Care Committee meeting, oversees the timely credentialing and/or recredentialing of facilities as well as practitioners and manages the assembly of quality and sanction reports for both types of contracted and credentialed entities.

　　Key Responsibilities/Duties – what you will be doing

　　Maintain best in class process documentation that meets all regulatory, client, and accreditation needs, and that lead to a successful credentialing program

　　Responsible to respond to Credentialing Audit activities including delegation oversight, accreditation audits, and client audits as necessary

　　Monitor and review credentialing activity and average turn-around-times & volumes and holds staff accountable to meet metrics and KPI’s

　　Develop and maintain a credentialing playbook that outlines best practices, and cost reduction opportunities via delegation or other innovations

　　Participate in miscellaneous internal and external company/departmental initiatives, taskforces, meetings and/or projects, as assigned by management

　　People management actives including performance reviews, performance improvements, support, and career pathing

　　Develops and maintains processes related to regulatory and accreditation requirements, specifically National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid (CMS), state regulatory bodies, and applicable laws and regulations for the credentialing of practitioners and organizational providers.

　　Manage the development, implementation, and evaluation of operational and quality improvement systems, including the credentialing software system, programs, processes, and workflows. Prioritize strategic initiatives and allocate resources accordingly.

　　Other duties and projects as assigned.

　　Qualifications – what you need to perform the job

　　Education, Certification and Licensure

　　B.A./B.S. or equivalent in health care or related field preferred, or commensurate experience requiredExperience (minimum years required) :

　　5-10 years of experience in a health care setting required.

　　3-5 years of supervisory experience preferred.

　　Supervisory and NCQA compliance experience required.

　　Process design experience required.

　　Experience with Medicare and Medicaid plans preferred but not required

　　Skill Requirements

　　Requires comprehensive knowledge of credentialing/recredentialing & delegation requirements in accordance with Point32Health, state laws and regulatory agencies (i.e., NCQA, etc.).

　　Proven ability to manage multiple responsibilities and ability to prioritize own and other’s work to achieve optimal efficiency.

　　Individual must demonstrate initiative, judgment, analytical capability, problem-solving skills, and the attention to detail necessary to operate in a complex environment.

　　Must have demonstrated ability to make general decisions in the absence of specific direction.

　　Requires the ability to supervise a staff charged with maintaining accurate and relevant credentialing information.

　　Excellent oral and written communication skills are necessary.

　　Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel) :

　　Must be able to work under normal office conditions and work from home as required.

　　Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.

　　May be required to work additional hours beyond standard work schedule.

　　The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.

　　Salary Range

　　102,605-132,783

　　Compensation & Total Rewards Overview

　　The annual base salary range provided for this position represents a broad range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; equity with internal colleagues; and other conditions of employment. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company’s sole discretion, consistent with the law.

　　Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:

　　Medical, dental and vision coverage

　　Retirement plans

　　Paid time off

　　Employer-paid life and disability insurance with additional buy-up coverage options

　　Tuition program

　　Well-being benefits

　　Full suite of benefits to support career development, individual & family health, and financial health

　　For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/

　　Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity

　　​Point32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we do—from product design to the workforce driving that innovation. Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team's strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

　　At Point32Health, we strive to be a different kind of nonprofit health and well-being company, with a broad range of health plans, and innovative tools that make navigating health and well-being easier, guiding our members at every step of their health care journey to better health outcomes. We are committed to providing high-quality and affordable health care, improving the health and wellness of our members, and creating healthier communities across the country. The Point32Health name is inspired by the 32 points on a compass. It speaks to the critical role we play in guiding and empowering the people we serve to achieve healthier lives. Our employees are hard-working, innovative, and collaborative. They look for opportunities to grow and make a difference, and they help make us strive to be one of the Top Places to work in New England.