PacificSource

PacificSource

Manager, Provider Credentialing and Operations

Boise, ID

Sponsorship not specified$90k-$158kDetected 2 days ago
ComplianceBusiness DevelopmentExcelAuditingPerformance ManagementHIPAALeadershipCommunicationCollaborationMentoringInternal Audit

About the role

  • Looking for a way to make an impact and help people?
  • Join PacificSource and help our members access quality, affordable care!
  • PacificSource is an equal opportunity employer.

Responsibilities

  • Manage daily operational performance and collaboration, as well as highlight team accomplishments.
  • Lead and manage all credentialing and recredentialing operations, ensuring compliance with NCQA, regulatory, and accreditation standards; oversee credentialing committee workflows and provider approval processes.
  • Design, implement, and continuously improve systems, processes, and workflows to enhance efficiency, data accuracy, and audit readiness across credentialing and provider data functions.
  • Advance data strategy initiatives, including data optimization, taxonomy, extraction, and reporting capabilities to support organizational and operational needs.
  • Maintain and manage delegated credentialing arrangements and support accreditation efforts, including ongoing readiness for NCQA and other regulatory reviews.
  • Partner cross-functionally with Provider Network Contracting, Provider Relations, and other departments to align processes, improve service delivery, and support business objectives.
  • Collaborate with internal and external stakeholders, including providers and vendor partners, to ensure accurate and effective credentialing and provider data operations.
  • Perform other duties as assigned.
  • Develop and implement adequate programs and processes ensuring complete programs that meets or exceeds requirements.
  • Identify, evaluate, and implement process improvements and technology solutions, including system enhancements and vendor tools (e.g., Cactus, Facets), to optimize performance and scalability.

Requirements

  • Ability to read and comprehend both written and spoken English.
  • It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position.
  • Bachelor's degree required.
  • Candidates with an associate's degree and 2 years of relevant experience, or a high school diploma and 4 years of relevant experience, in addition to the required minimum years of work experience will also be considered.
  • Ability to gain knowledge of PacificSource policies and procedures.

Nice to have

  • Prior supervisory experience is strongly preferred.

Skills

  • Compensation Disclaimer
  • Base Range:
  • $90,052.16 - $157,591.26
  • The wage range provided reflects the full range for this position.
  • Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity.

Compensation

  • The wage range provided reflects the full range for this position.
  • The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage.
  • Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity.
  • Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range.
  • Develop annual department budgets. Monitor spending versus the planned budget throughout the year and take corrective action where needed.

Benefits

  • Provide oversight of site surveys and medical record review processes, including associated travel, documentation, and compliance requirements.
  • Education, Certificates, Licenses: Bachelor's degree required.

Company info

  • We are committed to doing the right thing.
  • We are one team working toward a common goal.
  • We are each responsible for customer service.

Equal opportunity

  • equal opportunity employer.
  • We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
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This listing is sourced directly from PacificSource's careers page and normalized into a canonical job model.