Location:

\nMedical Lake, WASHINGTON\n

Job Type:

\nFullTime\nScheduled Hours\n40\nPosition Summary\nProvides operational leadership for WashU Medicine's delegated credentialing organization, special contracting and negotiation of managed care contract language. Works jointly with the Senior Director of Managed Care Financial Contracting and Rate Analysis to secure optimal terms of participation with third-party managed care organizations.\nJob Description\n

Primary Duties & Responsibilities:

\nManages WashU Medicine's delegated credentialing organization.\nManages WashU Physician's Network (WUPN). Develops and implements policies and procedures pertaining to collection, and scope, of information required to carry out credentialing and re-credentialing functions.\nDesigns and manages a centralized practitioner database and the mechanism for direct or indirect access by staff and representatives of affiliated organizations. Assures an accurate, complete, and well-documented information source.\nMaintains up-to-date knowledge of, and compliance with, credentialing standards established by the National Committee for Quality Assurance (NCQA), Joint Commission on the Accreditation of Healthcare Organization (JCAHO), Utilization Review Accreditation Commission (URAC), any state or federal medical staff credentialing requirements and the delegation agreement of any applicable care plans.\nAdvises administrative staff of affiliated physician organizations, hospitals, managed care plans and other third parties on issues pertaining to credentialing and re-credentialing.\nEstablishes and assures adherence to credentialing data confidentiality policy.\nDesigns and conducts training and educational programs as required to assure credentialing compliance standards with hospital programs, delegated credentialing corporate representative, credentialing bodies and the internal committees.\nDevelops infrastructure to assure the accuracy and consistency of the interface with the National Practitioner Data Bank (NPDB), Federation of State Medical Boards (FSMB) Medicare, Medicaid, medical schools, societies, and the Departments of Insurance or Health. Serves as authorized agent in reporting of adverse actions to any such organization.\nDesigns and executes the pre-application, application and reapplication process associated with credentialing and re-credentialing. Provides direct oversight of site visit nurse responsible for assessment of physician's office environment and medical records.\nCoordinates site audits by managed care plans, accrediting bodies and state or federal agencies.\nLeads medical school liaison for transplant contracting.\nMaintains operational oversite of WashU Medicine's single patient discount contracting service.\nResponsible for negotiation of managed care contract language and securing acceptable managed care language terms.\nWorks jointly with the Senior Director of Managed Care Financial Contracting and Rate Analysis to secure optimal financial terms for all third-party agreements.\nAlong with the Senior Director of Special Contracting and Contract Language, serves as the primary faculty practice plan liaison with BJC managed care contracting.\nPerforms other duties as assigned.\n

Working Conditions:

\nJob Location/Working Conditions\nNormal office environment Physical Effort\nTypically sitting at a desk or table Equipment\nOffice equipment The above statements are intended to describe the general nature and level of work performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all job duties performed by the personnel so classified. Management reserves the right to revise or amend duties at any time.\nRequired Qualifications\n

Education:

\nBachelor's degree\n

Certifications/Professional Licenses:

\nNo specific certification/professional license is required for this position.\n

Work Experience:

\nNo specific work experience is required for this position.\n

Skills:

\nNot Applicable\n

Driver's License:

\nA driver's license is not required for this position.\nMore About This Job\nWashU seeks highly motivated individuals who are able to perform duties in a manner consistent with our core mission and guiding principles.\nPreferred Qualifications\n

Education:

\nMaster's degree, Ph.D. - Doctor of Philosophy\n

Certifications/Professional Licenses:

\nNo additional certification/professional licenses unless stated elsewhere in the job posting.\n

Work Experience:

\nCredentialing Management And Managed Care Contracting In A Large Faculty Practice, Private Practice, Large Healthcare Or Third-Party Payor Organization (5 Years)\n

Skills:

\nAnalytical Thinking, Business, Conceptualize Ideas, Credentialing, Credential Management, Database Applications, External Partners, Finance, Interpersonal Interactions, Negotiation, Oral Communications, Provider Credentialing, Relational Database Management, Social Interaction, Spreadsheets, Word Processing Applications, Written Communication\nGrade\nG18\nSalary Range\n$129,800.00 - $228,400.00 / Annually\nThe salary range reflects base salaries paid for positions in a given job grade across the University. Individual rates within the range will be determined by factors including one's qualifications and performance, equity with others in the department, market rates for positions within the same grade and department budget.\nQuestions\nFor frequently asked questions about the application process, please refer to our External Applicant FAQ .\nAccommodation\nIf you are unable to use our online application system and would like an accommodation, please email CandidateQuestionswustl or call the dedicated accommodation inquiry number at 314-935-1149 and leave a voicemail with the nature of your request.\nAll qualified individuals must be able to perform the essential functions of the position satisfactorily and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions of their job, absent undue hardship.\nPre-Employment Screening\nAll external candidates receiving an offer for employment will be required to submit to pre-employment screening for this position. The screenings will include criminal background check and, as applicable for the position, other background checks, drug screen, an employment and education or licensure/certification verification, physical examination, certain vaccinations and/or governmental registry checks. 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