2,968 Molina Healthcare jobs in the United States
Managed Care Compliance Specialist - Managed Care
Posted today
Job Viewed
Job Description
The Managed Care Compliance Specialist is responsible for assisting with the implementation of the internal auditing and monitoring program within the Managed Care department by ensuring compliance with applicable rules and regulations including but not limited to AB1455 and Medicare Claims Processing Guidelines. This position is responsible for maintaining routine auditing functions and providing feedback on departmental activities, to assure compliance with all health plan and regulatory agencies, including CMS, DMHC, and DHCS.
Duties and Responsibilities:
+ Ensures all services provided to Commercial, Medicare and Medi-cal managed care members are in compliance with program regulations, insurance regulations, and regulatory requirements.
+ Maintains and tracks laws and regulations, contract documentations, amendments, and various compliance measures pertaining to Commercial, Medicare and Medi-cal managed care.
+ Develops policies, procedures, and processes to align with federal program regulations and any applicable state regulations pertaining to Commercial, Medicare and Medi-Cal managed care.
+ Provides mentorship to various departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language for Commercial, Medicare and Medi-Cal managed care.
+ Acts as a liaison with health plans and current CSHS departments to ensure both health plan regulations and CSHS policies are met.
+ Coordinates and act as primary contact for all health plans audits, including leading all aspects of the review for performance management and accurate coding.
+ Develops and supervise compliance with corrective action plans as a result of post-health plan audits and regulatory audits.
+ Provides required Compliance and FWA trainings for existing, new employees and non-employees, as the need arises.
+ Educates CSHS employees on company policies and procedures regarding access to care, the grievance and appeals process, the eligibility process, etc.
+ Remains updated on all member and provider policy changes made by the health plan and/or the State.
+ Acts as subject matter expert on health care laws/regulations as a compliance resource to CSHS and affiliates, including contracted and employed physician practices.
+ Aggregates, analyze, and report audit results, identify error trends and root causes, and make recommendations for performance improvements.
**Qualifications**
**Education:**
High school diploma/GED required. Bachelor's degree in Healthcare or related field preferred.
**Experience:**
Five (5) years of compliance experience, preferably in a healthcare environment, required. Two (2) years of Medi-Cal, Medicare or Commercial Managed Care experience preferred.
**About Us**
Cedars-Sinai is a leader in providing high-quality healthcare encompassing primary care, specialized medicine and research. Since 1902, Cedars-Sinai has evolved to meet the needs of one of the most diverse regions in the nation, setting standards in quality and innovative patient care, research, teaching and community service. Today, Cedars- Sinai is known for its national leadership in transforming healthcare for the benefit of patients. Cedars-Sinai impacts the future of healthcare by developing new approaches to treatment and educating tomorrow's health professionals. Additionally, Cedars-Sinai demonstrates a commitment to the community through programs that improve the health of its most vulnerable residents.
**About the Team**
With a growing number of primary urgent and specialty care locations across Southern California, Cedars-Sinai's medical network serves people near where they live. Delivering coordinated, compassionate healthcare you can join our network of clinicians and physicians to improve the healthcare people throughout Los Angeles and beyond.
**Req ID** : 11981
**Working Title** : Managed Care Compliance Specialist - Managed Care
**Department** : MNS Managed Care
**Business Entity** : Cedars-Sinai Medical Center
**Job Category** : Strategic Plan / Business Dev
**Job Specialty** : Managed Care
**Overtime Status** : EXEMPT
**Primary Shift** : Day
**Shift Duration** : 8 hour
**Base Pay** : $34.69 - $53.77
Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law.
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Manager, Managed Care
Posted today
Job Viewed
Job Description
**What Managed Care contributes to Cardinal Health**
Practice Operations Management oversees the business and administrative operations of a medical practice.
Managed Care oversees the interactions that take place between payer and provider(s) to ensure optimal reimbursement including managed care contracting, enrollment, credentialing, and any other activity as it relates to payer interaction.
The position is responsible for managing the credentialing team and ensuring an active credentialing status with all contracted payors for all Centers, Nurse Practitioners and employed physicians. The position is also responsible for ensuring that all licensure is updated and active for all the markets, clinicians and facilities.
**Essential Functions:**
+ Responsible for documenting and tracking all credentialing, re-credentialing, provider enrollment, and hospital privileging activities within the credentialing software environment.
+ Supervises, plans, directs, coordinates, and evaluates the product of team members.
+ Assists new providers with obtaining required clinical licenses and coordinates the full cycle onboarding and enrollment into Medicaid, Medicare, and the commercial insurance plans.
+ Establish policies, procedures, toolkits, and best practices necessary for successful provider onboarding, including established timeframes, required documentation, and checklists.
+ Maintain and monitor all licenses and certifications in the database to ensure compliance within all markets.
+ Coordination of provider enrollment activities (including initial enrollments or re-credentialing) for all Centers, employed physicians, and nurse practitioners.
+ Ensure all facility and practitioner licenses and certifications are accurate and in good standing at all times including renewing facility license and permits.
+ Complete all forms and supporting documents required to obtain hospital privileges for physicians, as necessary including renewal applications.
+ Ensure that all processing and reporting deadlines are consistently achieved.
+ Conducts weekly conference calls with the Clinical Operations teams to provide status updates of onboarding activities.
+ Meets regularly with the Director of Managed Care Contracting and other team members to provide updates on progress and status of credentialing and enrollment matters.
+ Participates in special projects, including acquisitions and de novo projects; opening new locations; adding new service lines, and closing facilities.
+ Assists the Revenue Cycle Team with claims denial research; finding out whether we are in-network with specific products, and other miscellaneous billing and collections issues.
+ Assists the Director of Managed Care with special contracts projects, including the loading of executed contracts into the iContracts database.
+ Performs any other functions as required by management.
+ Regular attendance and punctuality is required.
**Qualifications**
+ At least five (5) years of experience of credentialing experience in a managed care or provider setting, including experience using a credentialing database.
+ Demonstrated personnel leadership (remote and onsite), provider enrollment technical expertise, effective and professional communication, disciplined execution of strategic initiatives, and relationship management.
+ Specific knowledge of the payer environment and payer issues, particularly billing and collections.
+ Strong knowledge of the rules/regulations of Medicare/Medicaid and other government payors, as well as commercial insurers and specialty contracts to ensure accurate and timely billing and payment of claims.
+ Ability to work a flexible schedule (including overtime, and weekends), as necessary.
+ Excellent customer service and communication skills.
+ Ability to work independently and as part of a team.
+ Working experience with Excel spreadsheets and Microsoft Word documents.
+ College degree or commensurate working experience in healthcare.
+ Knowledge of basic medical terminology.
+ Credentialing database experience (such as IntelliCred, E-Vips, Vistar, Cactus, Symed, etc.)
**What is expected of you and others at this level**
+ Manages department operations and supervises professional employees, front line supervisors and/or business support staff
+ Participates in the development of policies and procedures to achieve specific goals
+ Ensures employees operate within guidelines
+ Decisions have a short term impact on work processes, outcomes and customers
+ Interacts with subordinates, peers, customers, and suppliers at various management levels; may interact with senior management
+ Interactions normally involve resolution of issues related to operations and/or projects
+ Gains consensus from various parties involved
**Anticipated hourly range:** 105,100K - 165,100K (Annual)
**Bonus eligible:** No
**Benefits:** Cardinal Health offers a wide variety of benefits and programs to support health and well-being.
+ Medical, dental and vision coverage
+ Paid time off plan
+ Health savings account (HSA)
+ 401k savings plan
+ Access to wages before pay day with myFlexPay
+ Flexible spending accounts (FSAs)
+ Short- and long-term disability coverage
+ Work-Life resources
+ Paid parental leave
+ Healthy lifestyle programs
**Application window anticipated to close:** 12/2/25 if interested in opportunity, please submit application as soon as possible.
The hourly range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity.
Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply.
_Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply._
_Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal_ _Opportunity/Affirmative_ _Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law._
_To read and review this privacy notice click_ here (
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Manager, Managed Care
Posted today
Job Viewed
Job Description
**What Managed Care contributes to Cardinal Health**
Practice Operations Management oversees the business and administrative operations of a medical practice.
Managed Care oversees the interactions that take place between payer and provider(s) to ensure optimal reimbursement including managed care contracting, enrollment, credentialing, and any other activity as it relates to payer interaction.
The position is responsible for managing the credentialing team and ensuring an active credentialing status with all contracted payors for all Centers, Nurse Practitioners and employed physicians. The position is also responsible for ensuring that all licensure is updated and active for all the markets, clinicians and facilities.
**Essential Functions:**
+ Responsible for documenting and tracking all credentialing, re-credentialing, provider enrollment, and hospital privileging activities within the credentialing software environment.
+ Supervises, plans, directs, coordinates, and evaluates the product of team members.
+ Assists new providers with obtaining required clinical licenses and coordinates the full cycle onboarding and enrollment into Medicaid, Medicare, and the commercial insurance plans.
+ Establish policies, procedures, toolkits, and best practices necessary for successful provider onboarding, including established timeframes, required documentation, and checklists.
+ Maintain and monitor all licenses and certifications in the database to ensure compliance within all markets.
+ Coordination of provider enrollment activities (including initial enrollments or re-credentialing) for all Centers, employed physicians, and nurse practitioners.
+ Ensure all facility and practitioner licenses and certifications are accurate and in good standing at all times including renewing facility license and permits.
+ Complete all forms and supporting documents required to obtain hospital privileges for physicians, as necessary including renewal applications.
+ Ensure that all processing and reporting deadlines are consistently achieved.
+ Conducts weekly conference calls with the Clinical Operations teams to provide status updates of onboarding activities.
+ Meets regularly with the Director of Managed Care Contracting and other team members to provide updates on progress and status of credentialing and enrollment matters.
+ Participates in special projects, including acquisitions and de novo projects; opening new locations; adding new service lines, and closing facilities.
+ Assists the Revenue Cycle Team with claims denial research; finding out whether we are in-network with specific products, and other miscellaneous billing and collections issues.
+ Assists the Director of Managed Care with special contracts projects, including the loading of executed contracts into the iContracts database.
+ Performs any other functions as required by management.
+ Regular attendance and punctuality is required.
**Qualifications**
+ At least five (5) years of experience of credentialing experience in a managed care or provider setting, including experience using a credentialing database.
+ Demonstrated personnel leadership (remote and onsite), provider enrollment technical expertise, effective and professional communication, disciplined execution of strategic initiatives, and relationship management.
+ Specific knowledge of the payer environment and payer issues, particularly billing and collections.
+ Strong knowledge of the rules/regulations of Medicare/Medicaid and other government payors, as well as commercial insurers and specialty contracts to ensure accurate and timely billing and payment of claims.
+ Ability to work a flexible schedule (including overtime, and weekends), as necessary.
+ Excellent customer service and communication skills.
+ Ability to work independently and as part of a team.
+ Working experience with Excel spreadsheets and Microsoft Word documents.
+ College degree or commensurate working experience in healthcare.
+ Knowledge of basic medical terminology.
+ Credentialing database experience (such as IntelliCred, E-Vips, Vistar, Cactus, Symed, etc.)
**What is expected of you and others at this level**
+ Manages department operations and supervises professional employees, front line supervisors and/or business support staff
+ Participates in the development of policies and procedures to achieve specific goals
+ Ensures employees operate within guidelines
+ Decisions have a short term impact on work processes, outcomes and customers
+ Interacts with subordinates, peers, customers, and suppliers at various management levels; may interact with senior management
+ Interactions normally involve resolution of issues related to operations and/or projects
+ Gains consensus from various parties involved
**Anticipated hourly range:** 105,100K - 165,100K (Annual)
**Bonus eligible:** No
**Benefits:** Cardinal Health offers a wide variety of benefits and programs to support health and well-being.
+ Medical, dental and vision coverage
+ Paid time off plan
+ Health savings account (HSA)
+ 401k savings plan
+ Access to wages before pay day with myFlexPay
+ Flexible spending accounts (FSAs)
+ Short- and long-term disability coverage
+ Work-Life resources
+ Paid parental leave
+ Healthy lifestyle programs
**Application window anticipated to close:** 12/2/25 if interested in opportunity, please submit application as soon as possible.
The hourly range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity.
Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply.
_Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply._
_Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal_ _Opportunity/Affirmative_ _Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law._
_To read and review this privacy notice click_ here (
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Managed Care Coordinator
Posted 1 day ago
Job Viewed
Job Description
**Time Type:** Full time
**Work Shift:** Day (United States of America)
**FLSA Status:** Non-Exempt
**When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives.**
Job Summary: Works collaboratively with primary care or specialty physicians, their patients and practices to coordinate and process managed care referrals and / or authorizations for patient care services, complying with BIDCO's and BIDMC's contractual rules for multiple managed care insurance payers.
**Job Description:**
**Essential Responsibilities:**
**Collaborates with referring physicians, patients and support staff to request, obtain, record, and attach primary and/or specialty care managed care referral and authorization requests for multiple managed care insurance payers for a high volume of patients.**
**Utilizes electronic technologies to initiate, request, and procure a high volume of referral and authorizations for multiple managed care payers.**
**Educates patients about the referral process, programs offered, and services provided at BIDMC and affiliated CareGroup institutions. Communicates to the provider and/or patient the level of care, number of visits being authorized.**
**Communicates with managed care payers to resolve patient referral management issues. As appropriate, coordinates referrals with hospital's discharge planner and registration and pre-certification admitting department as required by the insurance company.**
**Provides referral management training and oversight to department new hires. Contributes as a managed care resource for everyone on the unit including all patients, physicians, social workers, nurses, practice assistants, and support staff.**
**Runs daily, weekly, and monthly statistical referral management and booking reports; enters data obtained from the reports into Excel spreadsheets.**
**Coordinates daily with the Referral Specialist and the support staff team in the running of the referral management reports and enters information daily; collaborates on negative indicators to improve referral management outcomes.**
**Required Qualifications:**
**High School diploma or GED required. Associate's degree preferred.**
**1-3 years related work experience required.**
**Experience with computer systems required, including web based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint or Access.**
**Preferred Qualifications:**
**Two years of experience in referral management or insurance managed care environment.**
**Basic and complex medical coding and medical terminology.**
**Primary care experience.**
**As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment.**
**More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.**
**Equal Opportunity** **Employer/Veterans/Disabled**
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Manager, Managed Care
Posted today
Job Viewed
Job Description
**What Managed Care contributes to Cardinal Health**
Practice Operations Management oversees the business and administrative operations of a medical practice.
Managed Care oversees the interactions that take place between payer and provider(s) to ensure optimal reimbursement including managed care contracting, enrollment, credentialing, and any other activity as it relates to payer interaction.
The position is responsible for managing the credentialing team and ensuring an active credentialing status with all contracted payors for all Centers, Nurse Practitioners and employed physicians. The position is also responsible for ensuring that all licensure is updated and active for all the markets, clinicians and facilities.
**Essential Functions:**
+ Responsible for documenting and tracking all credentialing, re-credentialing, provider enrollment, and hospital privileging activities within the credentialing software environment.
+ Supervises, plans, directs, coordinates, and evaluates the product of team members.
+ Assists new providers with obtaining required clinical licenses and coordinates the full cycle onboarding and enrollment into Medicaid, Medicare, and the commercial insurance plans.
+ Establish policies, procedures, toolkits, and best practices necessary for successful provider onboarding, including established timeframes, required documentation, and checklists.
+ Maintain and monitor all licenses and certifications in the database to ensure compliance within all markets.
+ Coordination of provider enrollment activities (including initial enrollments or re-credentialing) for all Centers, employed physicians, and nurse practitioners.
+ Ensure all facility and practitioner licenses and certifications are accurate and in good standing at all times including renewing facility license and permits.
+ Complete all forms and supporting documents required to obtain hospital privileges for physicians, as necessary including renewal applications.
+ Ensure that all processing and reporting deadlines are consistently achieved.
+ Conducts weekly conference calls with the Clinical Operations teams to provide status updates of onboarding activities.
+ Meets regularly with the Director of Managed Care Contracting and other team members to provide updates on progress and status of credentialing and enrollment matters.
+ Participates in special projects, including acquisitions and de novo projects; opening new locations; adding new service lines, and closing facilities.
+ Assists the Revenue Cycle Team with claims denial research; finding out whether we are in-network with specific products, and other miscellaneous billing and collections issues.
+ Assists the Director of Managed Care with special contracts projects, including the loading of executed contracts into the iContracts database.
+ Performs any other functions as required by management.
+ Regular attendance and punctuality is required.
**Qualifications**
+ At least five (5) years of experience of credentialing experience in a managed care or provider setting, including experience using a credentialing database.
+ Demonstrated personnel leadership (remote and onsite), provider enrollment technical expertise, effective and professional communication, disciplined execution of strategic initiatives, and relationship management.
+ Specific knowledge of the payer environment and payer issues, particularly billing and collections.
+ Strong knowledge of the rules/regulations of Medicare/Medicaid and other government payors, as well as commercial insurers and specialty contracts to ensure accurate and timely billing and payment of claims.
+ Ability to work a flexible schedule (including overtime, and weekends), as necessary.
+ Excellent customer service and communication skills.
+ Ability to work independently and as part of a team.
+ Working experience with Excel spreadsheets and Microsoft Word documents.
+ College degree or commensurate working experience in healthcare.
+ Knowledge of basic medical terminology.
+ Credentialing database experience (such as IntelliCred, E-Vips, Vistar, Cactus, Symed, etc.)
**What is expected of you and others at this level**
+ Manages department operations and supervises professional employees, front line supervisors and/or business support staff
+ Participates in the development of policies and procedures to achieve specific goals
+ Ensures employees operate within guidelines
+ Decisions have a short term impact on work processes, outcomes and customers
+ Interacts with subordinates, peers, customers, and suppliers at various management levels; may interact with senior management
+ Interactions normally involve resolution of issues related to operations and/or projects
+ Gains consensus from various parties involved
**Anticipated hourly range:** 105,100K - 165,100K (Annual)
**Bonus eligible:** No
**Benefits:** Cardinal Health offers a wide variety of benefits and programs to support health and well-being.
+ Medical, dental and vision coverage
+ Paid time off plan
+ Health savings account (HSA)
+ 401k savings plan
+ Access to wages before pay day with myFlexPay
+ Flexible spending accounts (FSAs)
+ Short- and long-term disability coverage
+ Work-Life resources
+ Paid parental leave
+ Healthy lifestyle programs
**Application window anticipated to close:** 12/2/25 if interested in opportunity, please submit application as soon as possible.
The hourly range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity.
Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply.
_Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply._
_Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal_ _Opportunity/Affirmative_ _Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law._
_To read and review this privacy notice click_ here (
Is this job a match or a miss?
Manager, Managed Care
Posted today
Job Viewed
Job Description
**What Managed Care contributes to Cardinal Health**
Practice Operations Management oversees the business and administrative operations of a medical practice.
Managed Care oversees the interactions that take place between payer and provider(s) to ensure optimal reimbursement including managed care contracting, enrollment, credentialing, and any other activity as it relates to payer interaction.
The position is responsible for managing the credentialing team and ensuring an active credentialing status with all contracted payors for all Centers, Nurse Practitioners and employed physicians. The position is also responsible for ensuring that all licensure is updated and active for all the markets, clinicians and facilities.
**Essential Functions:**
+ Responsible for documenting and tracking all credentialing, re-credentialing, provider enrollment, and hospital privileging activities within the credentialing software environment.
+ Supervises, plans, directs, coordinates, and evaluates the product of team members.
+ Assists new providers with obtaining required clinical licenses and coordinates the full cycle onboarding and enrollment into Medicaid, Medicare, and the commercial insurance plans.
+ Establish policies, procedures, toolkits, and best practices necessary for successful provider onboarding, including established timeframes, required documentation, and checklists.
+ Maintain and monitor all licenses and certifications in the database to ensure compliance within all markets.
+ Coordination of provider enrollment activities (including initial enrollments or re-credentialing) for all Centers, employed physicians, and nurse practitioners.
+ Ensure all facility and practitioner licenses and certifications are accurate and in good standing at all times including renewing facility license and permits.
+ Complete all forms and supporting documents required to obtain hospital privileges for physicians, as necessary including renewal applications.
+ Ensure that all processing and reporting deadlines are consistently achieved.
+ Conducts weekly conference calls with the Clinical Operations teams to provide status updates of onboarding activities.
+ Meets regularly with the Director of Managed Care Contracting and other team members to provide updates on progress and status of credentialing and enrollment matters.
+ Participates in special projects, including acquisitions and de novo projects; opening new locations; adding new service lines, and closing facilities.
+ Assists the Revenue Cycle Team with claims denial research; finding out whether we are in-network with specific products, and other miscellaneous billing and collections issues.
+ Assists the Director of Managed Care with special contracts projects, including the loading of executed contracts into the iContracts database.
+ Performs any other functions as required by management.
+ Regular attendance and punctuality is required.
**Qualifications**
+ At least five (5) years of experience of credentialing experience in a managed care or provider setting, including experience using a credentialing database.
+ Demonstrated personnel leadership (remote and onsite), provider enrollment technical expertise, effective and professional communication, disciplined execution of strategic initiatives, and relationship management.
+ Specific knowledge of the payer environment and payer issues, particularly billing and collections.
+ Strong knowledge of the rules/regulations of Medicare/Medicaid and other government payors, as well as commercial insurers and specialty contracts to ensure accurate and timely billing and payment of claims.
+ Ability to work a flexible schedule (including overtime, and weekends), as necessary.
+ Excellent customer service and communication skills.
+ Ability to work independently and as part of a team.
+ Working experience with Excel spreadsheets and Microsoft Word documents.
+ College degree or commensurate working experience in healthcare.
+ Knowledge of basic medical terminology.
+ Credentialing database experience (such as IntelliCred, E-Vips, Vistar, Cactus, Symed, etc.)
**What is expected of you and others at this level**
+ Manages department operations and supervises professional employees, front line supervisors and/or business support staff
+ Participates in the development of policies and procedures to achieve specific goals
+ Ensures employees operate within guidelines
+ Decisions have a short term impact on work processes, outcomes and customers
+ Interacts with subordinates, peers, customers, and suppliers at various management levels; may interact with senior management
+ Interactions normally involve resolution of issues related to operations and/or projects
+ Gains consensus from various parties involved
**Anticipated hourly range:** 105,100K - 165,100K (Annual)
**Bonus eligible:** No
**Benefits:** Cardinal Health offers a wide variety of benefits and programs to support health and well-being.
+ Medical, dental and vision coverage
+ Paid time off plan
+ Health savings account (HSA)
+ 401k savings plan
+ Access to wages before pay day with myFlexPay
+ Flexible spending accounts (FSAs)
+ Short- and long-term disability coverage
+ Work-Life resources
+ Paid parental leave
+ Healthy lifestyle programs
**Application window anticipated to close:** 12/2/25 if interested in opportunity, please submit application as soon as possible.
The hourly range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity.
Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply.
_Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply._
_Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal_ _Opportunity/Affirmative_ _Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law._
_To read and review this privacy notice click_ here (
Is this job a match or a miss?
Manager, Managed Care
Posted today
Job Viewed
Job Description
**What Managed Care contributes to Cardinal Health**
Practice Operations Management oversees the business and administrative operations of a medical practice.
Managed Care oversees the interactions that take place between payer and provider(s) to ensure optimal reimbursement including managed care contracting, enrollment, credentialing, and any other activity as it relates to payer interaction.
The position is responsible for managing the credentialing team and ensuring an active credentialing status with all contracted payors for all Centers, Nurse Practitioners and employed physicians. The position is also responsible for ensuring that all licensure is updated and active for all the markets, clinicians and facilities.
**Essential Functions:**
+ Responsible for documenting and tracking all credentialing, re-credentialing, provider enrollment, and hospital privileging activities within the credentialing software environment.
+ Supervises, plans, directs, coordinates, and evaluates the product of team members.
+ Assists new providers with obtaining required clinical licenses and coordinates the full cycle onboarding and enrollment into Medicaid, Medicare, and the commercial insurance plans.
+ Establish policies, procedures, toolkits, and best practices necessary for successful provider onboarding, including established timeframes, required documentation, and checklists.
+ Maintain and monitor all licenses and certifications in the database to ensure compliance within all markets.
+ Coordination of provider enrollment activities (including initial enrollments or re-credentialing) for all Centers, employed physicians, and nurse practitioners.
+ Ensure all facility and practitioner licenses and certifications are accurate and in good standing at all times including renewing facility license and permits.
+ Complete all forms and supporting documents required to obtain hospital privileges for physicians, as necessary including renewal applications.
+ Ensure that all processing and reporting deadlines are consistently achieved.
+ Conducts weekly conference calls with the Clinical Operations teams to provide status updates of onboarding activities.
+ Meets regularly with the Director of Managed Care Contracting and other team members to provide updates on progress and status of credentialing and enrollment matters.
+ Participates in special projects, including acquisitions and de novo projects; opening new locations; adding new service lines, and closing facilities.
+ Assists the Revenue Cycle Team with claims denial research; finding out whether we are in-network with specific products, and other miscellaneous billing and collections issues.
+ Assists the Director of Managed Care with special contracts projects, including the loading of executed contracts into the iContracts database.
+ Performs any other functions as required by management.
+ Regular attendance and punctuality is required.
**Qualifications**
+ At least five (5) years of experience of credentialing experience in a managed care or provider setting, including experience using a credentialing database.
+ Demonstrated personnel leadership (remote and onsite), provider enrollment technical expertise, effective and professional communication, disciplined execution of strategic initiatives, and relationship management.
+ Specific knowledge of the payer environment and payer issues, particularly billing and collections.
+ Strong knowledge of the rules/regulations of Medicare/Medicaid and other government payors, as well as commercial insurers and specialty contracts to ensure accurate and timely billing and payment of claims.
+ Ability to work a flexible schedule (including overtime, and weekends), as necessary.
+ Excellent customer service and communication skills.
+ Ability to work independently and as part of a team.
+ Working experience with Excel spreadsheets and Microsoft Word documents.
+ College degree or commensurate working experience in healthcare.
+ Knowledge of basic medical terminology.
+ Credentialing database experience (such as IntelliCred, E-Vips, Vistar, Cactus, Symed, etc.)
**What is expected of you and others at this level**
+ Manages department operations and supervises professional employees, front line supervisors and/or business support staff
+ Participates in the development of policies and procedures to achieve specific goals
+ Ensures employees operate within guidelines
+ Decisions have a short term impact on work processes, outcomes and customers
+ Interacts with subordinates, peers, customers, and suppliers at various management levels; may interact with senior management
+ Interactions normally involve resolution of issues related to operations and/or projects
+ Gains consensus from various parties involved
**Anticipated hourly range:** 105,100K - 165,100K (Annual)
**Bonus eligible:** No
**Benefits:** Cardinal Health offers a wide variety of benefits and programs to support health and well-being.
+ Medical, dental and vision coverage
+ Paid time off plan
+ Health savings account (HSA)
+ 401k savings plan
+ Access to wages before pay day with myFlexPay
+ Flexible spending accounts (FSAs)
+ Short- and long-term disability coverage
+ Work-Life resources
+ Paid parental leave
+ Healthy lifestyle programs
**Application window anticipated to close:** 12/2/25 if interested in opportunity, please submit application as soon as possible.
The hourly range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity.
Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply.
_Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply._
_Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal_ _Opportunity/Affirmative_ _Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law._
_To read and review this privacy notice click_ here (
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Manager, Managed Care
Posted today
Job Viewed
Job Description
**What Managed Care contributes to Cardinal Health**
Practice Operations Management oversees the business and administrative operations of a medical practice.
Managed Care oversees the interactions that take place between payer and provider(s) to ensure optimal reimbursement including managed care contracting, enrollment, credentialing, and any other activity as it relates to payer interaction.
The position is responsible for managing the credentialing team and ensuring an active credentialing status with all contracted payors for all Centers, Nurse Practitioners and employed physicians. The position is also responsible for ensuring that all licensure is updated and active for all the markets, clinicians and facilities.
**Essential Functions:**
+ Responsible for documenting and tracking all credentialing, re-credentialing, provider enrollment, and hospital privileging activities within the credentialing software environment.
+ Supervises, plans, directs, coordinates, and evaluates the product of team members.
+ Assists new providers with obtaining required clinical licenses and coordinates the full cycle onboarding and enrollment into Medicaid, Medicare, and the commercial insurance plans.
+ Establish policies, procedures, toolkits, and best practices necessary for successful provider onboarding, including established timeframes, required documentation, and checklists.
+ Maintain and monitor all licenses and certifications in the database to ensure compliance within all markets.
+ Coordination of provider enrollment activities (including initial enrollments or re-credentialing) for all Centers, employed physicians, and nurse practitioners.
+ Ensure all facility and practitioner licenses and certifications are accurate and in good standing at all times including renewing facility license and permits.
+ Complete all forms and supporting documents required to obtain hospital privileges for physicians, as necessary including renewal applications.
+ Ensure that all processing and reporting deadlines are consistently achieved.
+ Conducts weekly conference calls with the Clinical Operations teams to provide status updates of onboarding activities.
+ Meets regularly with the Director of Managed Care Contracting and other team members to provide updates on progress and status of credentialing and enrollment matters.
+ Participates in special projects, including acquisitions and de novo projects; opening new locations; adding new service lines, and closing facilities.
+ Assists the Revenue Cycle Team with claims denial research; finding out whether we are in-network with specific products, and other miscellaneous billing and collections issues.
+ Assists the Director of Managed Care with special contracts projects, including the loading of executed contracts into the iContracts database.
+ Performs any other functions as required by management.
+ Regular attendance and punctuality is required.
**Qualifications**
+ At least five (5) years of experience of credentialing experience in a managed care or provider setting, including experience using a credentialing database.
+ Demonstrated personnel leadership (remote and onsite), provider enrollment technical expertise, effective and professional communication, disciplined execution of strategic initiatives, and relationship management.
+ Specific knowledge of the payer environment and payer issues, particularly billing and collections.
+ Strong knowledge of the rules/regulations of Medicare/Medicaid and other government payors, as well as commercial insurers and specialty contracts to ensure accurate and timely billing and payment of claims.
+ Ability to work a flexible schedule (including overtime, and weekends), as necessary.
+ Excellent customer service and communication skills.
+ Ability to work independently and as part of a team.
+ Working experience with Excel spreadsheets and Microsoft Word documents.
+ College degree or commensurate working experience in healthcare.
+ Knowledge of basic medical terminology.
+ Credentialing database experience (such as IntelliCred, E-Vips, Vistar, Cactus, Symed, etc.)
**What is expected of you and others at this level**
+ Manages department operations and supervises professional employees, front line supervisors and/or business support staff
+ Participates in the development of policies and procedures to achieve specific goals
+ Ensures employees operate within guidelines
+ Decisions have a short term impact on work processes, outcomes and customers
+ Interacts with subordinates, peers, customers, and suppliers at various management levels; may interact with senior management
+ Interactions normally involve resolution of issues related to operations and/or projects
+ Gains consensus from various parties involved
**Anticipated hourly range:** 105,100K - 165,100K (Annual)
**Bonus eligible:** No
**Benefits:** Cardinal Health offers a wide variety of benefits and programs to support health and well-being.
+ Medical, dental and vision coverage
+ Paid time off plan
+ Health savings account (HSA)
+ 401k savings plan
+ Access to wages before pay day with myFlexPay
+ Flexible spending accounts (FSAs)
+ Short- and long-term disability coverage
+ Work-Life resources
+ Paid parental leave
+ Healthy lifestyle programs
**Application window anticipated to close:** 12/2/25 if interested in opportunity, please submit application as soon as possible.
The hourly range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity.
Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply.
_Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply._
_Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal_ _Opportunity/Affirmative_ _Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law._
_To read and review this privacy notice click_ here (
Is this job a match or a miss?
Manager, Managed Care
Posted today
Job Viewed
Job Description
**What Managed Care contributes to Cardinal Health**
Practice Operations Management oversees the business and administrative operations of a medical practice.
Managed Care oversees the interactions that take place between payer and provider(s) to ensure optimal reimbursement including managed care contracting, enrollment, credentialing, and any other activity as it relates to payer interaction.
The position is responsible for managing the credentialing team and ensuring an active credentialing status with all contracted payors for all Centers, Nurse Practitioners and employed physicians. The position is also responsible for ensuring that all licensure is updated and active for all the markets, clinicians and facilities.
**Essential Functions:**
+ Responsible for documenting and tracking all credentialing, re-credentialing, provider enrollment, and hospital privileging activities within the credentialing software environment.
+ Supervises, plans, directs, coordinates, and evaluates the product of team members.
+ Assists new providers with obtaining required clinical licenses and coordinates the full cycle onboarding and enrollment into Medicaid, Medicare, and the commercial insurance plans.
+ Establish policies, procedures, toolkits, and best practices necessary for successful provider onboarding, including established timeframes, required documentation, and checklists.
+ Maintain and monitor all licenses and certifications in the database to ensure compliance within all markets.
+ Coordination of provider enrollment activities (including initial enrollments or re-credentialing) for all Centers, employed physicians, and nurse practitioners.
+ Ensure all facility and practitioner licenses and certifications are accurate and in good standing at all times including renewing facility license and permits.
+ Complete all forms and supporting documents required to obtain hospital privileges for physicians, as necessary including renewal applications.
+ Ensure that all processing and reporting deadlines are consistently achieved.
+ Conducts weekly conference calls with the Clinical Operations teams to provide status updates of onboarding activities.
+ Meets regularly with the Director of Managed Care Contracting and other team members to provide updates on progress and status of credentialing and enrollment matters.
+ Participates in special projects, including acquisitions and de novo projects; opening new locations; adding new service lines, and closing facilities.
+ Assists the Revenue Cycle Team with claims denial research; finding out whether we are in-network with specific products, and other miscellaneous billing and collections issues.
+ Assists the Director of Managed Care with special contracts projects, including the loading of executed contracts into the iContracts database.
+ Performs any other functions as required by management.
+ Regular attendance and punctuality is required.
**Qualifications**
+ At least five (5) years of experience of credentialing experience in a managed care or provider setting, including experience using a credentialing database.
+ Demonstrated personnel leadership (remote and onsite), provider enrollment technical expertise, effective and professional communication, disciplined execution of strategic initiatives, and relationship management.
+ Specific knowledge of the payer environment and payer issues, particularly billing and collections.
+ Strong knowledge of the rules/regulations of Medicare/Medicaid and other government payors, as well as commercial insurers and specialty contracts to ensure accurate and timely billing and payment of claims.
+ Ability to work a flexible schedule (including overtime, and weekends), as necessary.
+ Excellent customer service and communication skills.
+ Ability to work independently and as part of a team.
+ Working experience with Excel spreadsheets and Microsoft Word documents.
+ College degree or commensurate working experience in healthcare.
+ Knowledge of basic medical terminology.
+ Credentialing database experience (such as IntelliCred, E-Vips, Vistar, Cactus, Symed, etc.)
**What is expected of you and others at this level**
+ Manages department operations and supervises professional employees, front line supervisors and/or business support staff
+ Participates in the development of policies and procedures to achieve specific goals
+ Ensures employees operate within guidelines
+ Decisions have a short term impact on work processes, outcomes and customers
+ Interacts with subordinates, peers, customers, and suppliers at various management levels; may interact with senior management
+ Interactions normally involve resolution of issues related to operations and/or projects
+ Gains consensus from various parties involved
**Anticipated hourly range:** 105,100K - 165,100K (Annual)
**Bonus eligible:** No
**Benefits:** Cardinal Health offers a wide variety of benefits and programs to support health and well-being.
+ Medical, dental and vision coverage
+ Paid time off plan
+ Health savings account (HSA)
+ 401k savings plan
+ Access to wages before pay day with myFlexPay
+ Flexible spending accounts (FSAs)
+ Short- and long-term disability coverage
+ Work-Life resources
+ Paid parental leave
+ Healthy lifestyle programs
**Application window anticipated to close:** 12/2/25 if interested in opportunity, please submit application as soon as possible.
The hourly range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity.
Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply.
_Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply._
_Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal_ _Opportunity/Affirmative_ _Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law._
_To read and review this privacy notice click_ here (
Is this job a match or a miss?
Manager, Managed Care
Posted today
Job Viewed
Job Description
**What Managed Care contributes to Cardinal Health**
Practice Operations Management oversees the business and administrative operations of a medical practice.
Managed Care oversees the interactions that take place between payer and provider(s) to ensure optimal reimbursement including managed care contracting, enrollment, credentialing, and any other activity as it relates to payer interaction.
The position is responsible for managing the credentialing team and ensuring an active credentialing status with all contracted payors for all Centers, Nurse Practitioners and employed physicians. The position is also responsible for ensuring that all licensure is updated and active for all the markets, clinicians and facilities.
**Essential Functions:**
+ Responsible for documenting and tracking all credentialing, re-credentialing, provider enrollment, and hospital privileging activities within the credentialing software environment.
+ Supervises, plans, directs, coordinates, and evaluates the product of team members.
+ Assists new providers with obtaining required clinical licenses and coordinates the full cycle onboarding and enrollment into Medicaid, Medicare, and the commercial insurance plans.
+ Establish policies, procedures, toolkits, and best practices necessary for successful provider onboarding, including established timeframes, required documentation, and checklists.
+ Maintain and monitor all licenses and certifications in the database to ensure compliance within all markets.
+ Coordination of provider enrollment activities (including initial enrollments or re-credentialing) for all Centers, employed physicians, and nurse practitioners.
+ Ensure all facility and practitioner licenses and certifications are accurate and in good standing at all times including renewing facility license and permits.
+ Complete all forms and supporting documents required to obtain hospital privileges for physicians, as necessary including renewal applications.
+ Ensure that all processing and reporting deadlines are consistently achieved.
+ Conducts weekly conference calls with the Clinical Operations teams to provide status updates of onboarding activities.
+ Meets regularly with the Director of Managed Care Contracting and other team members to provide updates on progress and status of credentialing and enrollment matters.
+ Participates in special projects, including acquisitions and de novo projects; opening new locations; adding new service lines, and closing facilities.
+ Assists the Revenue Cycle Team with claims denial research; finding out whether we are in-network with specific products, and other miscellaneous billing and collections issues.
+ Assists the Director of Managed Care with special contracts projects, including the loading of executed contracts into the iContracts database.
+ Performs any other functions as required by management.
+ Regular attendance and punctuality is required.
**Qualifications**
+ At least five (5) years of experience of credentialing experience in a managed care or provider setting, including experience using a credentialing database.
+ Demonstrated personnel leadership (remote and onsite), provider enrollment technical expertise, effective and professional communication, disciplined execution of strategic initiatives, and relationship management.
+ Specific knowledge of the payer environment and payer issues, particularly billing and collections.
+ Strong knowledge of the rules/regulations of Medicare/Medicaid and other government payors, as well as commercial insurers and specialty contracts to ensure accurate and timely billing and payment of claims.
+ Ability to work a flexible schedule (including overtime, and weekends), as necessary.
+ Excellent customer service and communication skills.
+ Ability to work independently and as part of a team.
+ Working experience with Excel spreadsheets and Microsoft Word documents.
+ College degree or commensurate working experience in healthcare.
+ Knowledge of basic medical terminology.
+ Credentialing database experience (such as IntelliCred, E-Vips, Vistar, Cactus, Symed, etc.)
**What is expected of you and others at this level**
+ Manages department operations and supervises professional employees, front line supervisors and/or business support staff
+ Participates in the development of policies and procedures to achieve specific goals
+ Ensures employees operate within guidelines
+ Decisions have a short term impact on work processes, outcomes and customers
+ Interacts with subordinates, peers, customers, and suppliers at various management levels; may interact with senior management
+ Interactions normally involve resolution of issues related to operations and/or projects
+ Gains consensus from various parties involved
**Anticipated hourly range:** 105,100K - 165,100K (Annual)
**Bonus eligible:** No
**Benefits:** Cardinal Health offers a wide variety of benefits and programs to support health and well-being.
+ Medical, dental and vision coverage
+ Paid time off plan
+ Health savings account (HSA)
+ 401k savings plan
+ Access to wages before pay day with myFlexPay
+ Flexible spending accounts (FSAs)
+ Short- and long-term disability coverage
+ Work-Life resources
+ Paid parental leave
+ Healthy lifestyle programs
**Application window anticipated to close:** 12/2/25 if interested in opportunity, please submit application as soon as possible.
The hourly range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity.
Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply.
_Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply._
_Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal_ _Opportunity/Affirmative_ _Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law._
_To read and review this privacy notice click_ here (
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Explore career opportunities at Molina Healthcare, a leading healthcare organization committed to providing quality healthcare services to individuals and families. Discover various job openings that align with your skills and career aspirations within the