Credentialing Senior Supervisor - AZ Hybrid - Evernorth Care Group (Healthcare)

Purpose of Position: Responsible for supervising the credentialing department that oversees medical staff, collaborating providers, and allied health credentialing related to granting privileges for Evernorth Care Group and its affiliates.

Work hours: Typically, Monday-Friday Salaried Hours based on the department needs. Work from home majority of the time.

Primary Job Duties and Responsibilities:

• Leads Provider Credentialing team with full technical responsibility for team output.
• Focuses on ensuring short-term outputs and the effectiveness of team integration with other work areas. Provides input into workforce planning and recruitment activities.
• May lead department projects. Supports and provides direction to more junior professionals.
• Supports the department in the organization and analysis of information.
• Acts as a subject matter expert.
• Maintains all credentialing and re-credentialing policies and processes and ensures that they are in compliance with NCQA and all applicable state regulations.
• Maintains a professional, positive work environment that promotes high performance.
• Provides day-to-day leadership, coaching, and development opportunity College degree or related work experience.
• Knowledge of NCQA accreditation standards preferred.
• Ability to work with limited supervision and as part of a team.
• Ability to effectively interact with all levels of the organization.
• Strong analytical skills
• Coordinates all aspects of credentialing, including initial appointment, reappointment, and privileging. Responsible for data administration for medical staff credentialing software and databases.
• Implements and monitors the procedures for the credentialing or re-credentialing of physicians and/or providers.
• Tracks delegation oversight activity and re-credentialing activity and corrective actions. Documents peer review activities and materials.
• Performs or supports on site state and internal audits.
• Coordinates credentialing reporting systems to monitor credentialing/re-credentialing activity, delegation oversight, vendor management, sanction monitoring and facility credentialing/re-credentialing activities.
• Partners with contracting in negotiating contracts with delegated vendors. Manages data preparation and assists with development of recommendations for credentialing committee review and approval.
• Works autonomously, only requiring "expert" level technical support from others.
• Exercises judgment in the evaluation, selection, and adaptation of both standard and complex techniques and procedures.
• Utilizes in-depth professional knowledge and acumen to develop models and procedures, and monitor trends, within Credentialing and data, and provides expertise in statistical analysis and quantitative processes.

Education and Minimum Requirements:

• Associate Degree in Medical Staff Service Science or other AA Degree in business. Or a related field of study or an equivalent combination of training and experience.
• Five years recent experience in medical staff services field including extensive credentialing and privileging and roster management experience.
• Management experience or equivalent experience in a leadership position
• Knowledge of state/federal regulatory requirements and accreditation standards related to the organization of medical staff.
• Have excellent customer service skills, time management, organization skills and communication skills.

Advanced Requirements:

• Valid certificate as a Certified Provider Credentialing Specialist and/or Certified Professional Medical Services Management (CPMSC). Certification must be maintained by achievement of CEU requirements at least every three years.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

About Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.