• Credentialing Manager/ Lead

    Job Locations US-OH-Columbus
    Posted Date 2 months ago(12/6/2019 11:47 AM)
    Requisition ID
    # of Openings
    Job Schedule
    Regular Full-Time

    Since 1975, MAXIMUS has operated under its founding mission of Helping Government Serve the People, enabling citizens around the globe to successfully engage with their governments at all levels and across a variety of health and human services programs. MAXIMUS delivers innovative business process management and technology solutions that contribute to improved outcomes for citizens and higher levels of productivity, accuracy, accountability and efficiency of government-sponsored programs. With more than 30,000 employees worldwide, MAXIMUS is a proud partner to government agencies in the United States, Australia, Canada, Saudi Arabia, Singapore and the United Kingdom. For more information, visit

    Job Description Summary

    We are looking for a Credentialing Manager/Lead managing a Provider component for Ohio Department of Health.


    1. Manages the central provider credentialing functions, special services for providers and field operations including provider liaison activities where applicable, provider training and outreach, materials development and provider recruitment for the Ohio Department of Health project.
    2. Makes recommendations for operational changes to improve all functions for credentialing activities.
    3. Oversees the administration of Primary Source Verifications of all provider due to credentials and re-credentialing.
    4. Manages the scheduling and performance of staff to ensure compliance with contract requirements.
    5. Manages processes by which provider calls are handled and ensures that questions and concerns are handled accurately, consistently, and on a timely basis.
    6. Manages the development and maintenance of all training materials and arrangements for all trainings, and outreach/materials development staff.
    7. Ensures that all regular and ad hoc reports are submitted accurately and on time.
    8. Meets all standards established for this position.
    9. Performs other duties as may be assigned by management.


    Must have a minimum of three (3) years of experience in managing a Provider component of a State’s MMIS, or similar health care provider component, experience working with culturally, linguistically diverse, and disadvantaged populations in a courteous and effective manner; knowledge of quality assurance performance monitoring; excellent management and supervisory skills, including extensive experience with employee relations; computer literate; excellent organizational, written, and verbal communication skills; ability to perform comfortably in a fast-paced, deadline-oriented work environment; ability to successfully execute many complex tasks simultaneously; ability to work as a team member, as well as independently. Maintain regular cooperation and compliance with all regulatory, accrediting, and membership-based organizations; create and carry out various credentialing processes in relation to physicians, medical assistants, and various other healthcare professionals; ensure that all personnel and services adhere to facility and staff policies, department guidelines, regulations, and government laws.
    Preferred qualifications include a Bachelor's degree from an accredited college or university in health, social services, or a related field.


    Essential Duties and Responsibilities:
    - Ensure project compliance with all operational requirements of the contract as well as corporate policies.
    - Manage Customer Service and Outreach Programs.
    - Manage direct reports and the cost- effective operation of all project tasks.
    - Supervise subcontractors that provide services to program.
    - Oversee audits of operations.
    - Produce monthly Service Level Agreement (SLA) report for client, as well as ad hoc reporting.
    - Collaborate with other Managers to ensure effective coordination of activities.
    - Develop and implement operational policies and procedures in collaboration with other key stakeholders.
    - Establish and maintains effective relationships with clients and other external entities.
    - Oversee the development and implementation of innovative methodologies to improve service levels and overall operation efficiency.
    - Supervise the project’s quality assurance and training programs as well as corrective actions to ensure compliance.
    - Monitor performance against key indicators established internally or by the clients.
    - Generate solutions to issues or complex problems.
    - Develop performance goals and objectives for staff, and monitor achievement of those goals.
    - Perform other duties as may be assigned.

    Minimum Requirements:
    - Bachelor degree or equivalent combination of education, technical training or work experience considered in lieu of degree, three (3) years of management experience, five (5) years of related experience.
    - Able to manage large-scale operations, including single or multiple sites.
    - Proven ability with operational analyses, processes and performance indicators.
    - Capable of performing comfortably in a fast- paced, deadline- oriented work environment.
    - Strong client management skills.
    - Able to successfully execute many complex tasks simultaneously.
    - Excellent organization, written and verbal communication skills
    - Capable of working as a team member as well as independently


    EEO Statement: Active military service members, their spouses, and veteran candidates often embody the core competencies MAXIMUS deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We’re proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. MAXIMUS is an Affirmative Action/Equal Opportunity Employer. MAXIMUS provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.


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