Under limited supervision, you will supervise the CirrusMD Provider Network’s (CMDPN) licensing and credentialing functions and assigned team. Job will oversee development, management and monitoring processes and procedures that support the initial application and renewals of state medical licensing, insurance plan enrollments, and internal credentialing including delegated credentialing contract processes. Ensures compliance with the appropriate accrediting and regulatory agencies. Supervises staff in the day-to-day management of the overall CMDPN licensing and credentialing process and database management. This position reports to the Director of Clinical Operations.
What You’ll Be Responsible For Achieving:
Manages the CMDPN licensing process for all CirrusMD clinical providers, in accordance with Federal and State laws, and CirrusMD policies.
Coordinates the management of the licensing database, ensuring accuracy of data and reporting to partnering systems. Monitors critical data for extensive analysis and report generation.
Coordinates the oversight of CMDPN contractors hired to support the licensing application process.
Works closely with physicians to successfully gather necessary information and forms for State Medical applications.
Complete applications through to submission and approval for any work not assigned externally.
Monitors the expirables process to ensure all clinical provider licenses and certificates remain current, ensuring appropriate notification prior to expiration.
Monitors and reports turnaround times of Medical licensing approval across all 50 states.
Manages licensing procedures; develops, recommends, and/or implements changes, revisions, and enhancements as appropriate to current operating environment.
Tracks and reports on annual CME earned by the providers.
Manages the CMDPN credentialing process for all CirrusMD clinical providers, in accordance with NCQA, Delegated contracts and CMS accreditation standards, Federal and State laws, and CirrusMD policies.
Coordinates the management of the credentialing database, ensuring accuracy of data and reporting to partnering systems. Monitors critical data for extensive analysis and report generation.
Coordinates the management of CMDPN credentialing applications, to ensure distribution, receipt, processing, and timely management through our credentialing process.
Coordinates the management of the expirables process to ensure all clinical provider licenses and certificates remain current, ensuring appropriate notification prior to expiration.
Monitors and reports turnaround times for processing of credentials applications, with continued focus on delivery of a high quality product, with the greatest efficiency, in the least amount of time, and in accordance to CMDPN policy timelines.
Manages Credentialing policies and procedures; develops, recommends, and/or implements changes, revisions, and enhancements as appropriate to current operating environment.
Provides consultations with regards to credentialing practices and services; prepares and conducts credentialing orientations and provides updates as appropriate on new policies and procedures.
Analyzes NCQA, delegation contract, state laws and CMS standards and develops criteria to ensure compliance; revises general aspects of credentialing and privileging process as necessary; makes recommendations for and implements changes in policies and procedures.
Prepares for and coordinates credentialing audits in compliance with the managed care delegated credentialing contracts and accreditation bodies.
Functions as primary CMDPN credentials contact for all internal and external inquiries; develops and maintains positive working relationships.
Represents CMDPN to internal and external customers as appropriate; makes presentations to and interacts with various internal and external customers on issues pertinent to area of specialty.
Maintains the CMPND Provider Directory. Keeps all necessary parties updated with changes to the Network provider list and field any inquiries regarding provider CMDPN credentialing.
Performs miscellaneous job-related duties as assigned.
This candidate should also have a strong interest in helping us improve how healthcare is delivered.
If you thrive in an entrepreneurial, fast-paced environment, then this might be the right opportunity for you.
What Will Make You Successful:
3-5 year of experience in licensing and credentialing preferred
Preference for earned bachelor’s degree and/or at least 5 years of experience directly related to the duties and responsibilities specified.
Certification/Licensure NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) or actively pursuing certification is preferred.
Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis.
What Will Make You Stand Out:
Ability to make administrative/procedural decisions and judgments.
Ability to work independently; seeking help as necessary
Ability to investigate and analyze information and draw conclusions.
Ability to develop and deliver presentations.
Ability to process computer data and to format and generate reports.
Ability to communicate effectively, both orally and in writing.
Ability to foster a cooperative work environment.
Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
Skill in developing policy and procedure documentation.
Database management skills.
Employee development and performance management skills.
Knowledge of related accreditation and certification requirements.
Knowledge of medical credentialing and privileging procedures and standards.
Knowledge of medical staff policies, regulations, and bylaws and the legal environment within which they operate.
Prior experience with credentialing and Licensing of Medical providers
Internal Number: Clinical 010
Who We Are:
CirrusMD provides simple, effective care when you need it. We help health plans and employers create happier, healthier, and more engaged members by giving them access to on-demand virtual care solutions that they love to engage with. Our text-first care delivery platform connects members to a dedicated, board-certified physician in under 60 seconds from any web-enabled device, with no cost and no time limits attached. CirrusMD enables stress-free, human care conversation that doesn’t end until members get the answers (and peace of mind) they need to manage their wellness.
CirrusMD has partnered with over a dozen major national payers, employers, and integrated delivery networks to deliver extraordinary virtual care to millions of lives across the nation. The company was founded in 2012 and is headquartered in Denver, CO.