14 Unitedhealth Group jobs in New York

The Managed Care Coordinator will coordinate the provision of inpatient chemical dependency treatment services with third party payers, including commercial insurers and managed care companies. He/She will coordinate inpatient care with other assigned staff through entire treatment cycle. Facilitate authorization and concurrent review processes for all third party insured inpatients. Perform comprehensive psychosocial assessments on prospective patients, as needed. Work collaboratively and manage all relevant information from medical, nursing, and counseling staff needed to present patient case to insurance entities to attain proper authorization for patient stays. Maintain and disseminate updated insurance entity information including changes in managing entities, plan changes, hours of operation, contact information and all other relevant information with regards to authorization policies and procedures. Work in conjunction with BHS Central Intake staff on coordination of patient's insurance benefits. Performs care management functions for inpatients, as needed. Maintain relationships with other agencies and individuals wishing to make referrals to the program; coordinate discharges as needed. Remain current on policies and procedures of insurance companies to facilitate coordination of program's financial responsibilities. Maintain and prepare statistical data, reports, and correspondence as required for agency, county and state, as assigned. Maintain clinical records in compliance with all regulatory bodies and SJRH/BHS policies and procedures.

CASAC, LMSW, LMHC or other NYS recognized QHP required. Five or more years of treatment experience specific to chemical dependency treatment is required; inpatient detoxification and rehabilitation experience preferred. 3-5 years of experience dealing with managed care/ insurance companies is required.

Salary:
$18.50 - $23.07/Hour

Overview:

Managed Care Coordinator Overview

The Managed Care Coordinator assists and supports the LPN/RN MDS Coordinator with case management responsibilities. The candidate is the primary liaison between the SNF and the HMO Managed Care Insurance Companies. This includes all types of communication (eFax, email, scan documents, phone calls) with case managers to provide concurrent updates as requested by Insurance Companies, handles Third Party appeals, peer to peers as applicable and with clinical oversight provided by the LPN/RN MDS Coordinator. Attends team meetings at the discretion of the MDS Coordinator.

Managed Care Coordinator Essential Job Fuctions

• Able to successfully interact with HMO Case Managers in a professional manner.
• Duties include scanning the documents from the EMR after the MDS Coordinator reviews.
• Participate in interdisciplinary team meetings as needed by the MDS Coordinator.
• Understands the organization's quality management program and the care coordinators role within that program, with compliance of all policies and procedures.
• Maintains privacy, as per policies and procedures within a secure environment of documentation and communication.
• Embraces change; maintains an open mind and is flexible and adaptable in the face of ambiguity and change.
• Utilizes electronic timekeeping system as directed.
• Arrives to work on time, regularly, and works as scheduled.
• Recognizes and follows the dress code of the facility including wearing name tag at all times.
• Follows policy and procedure regarding all electronic devices, computers, tablets, etc.
• Supports and abides by Elderwoods Mission, Vision, and Values.
• Abides by Elderwoods businesses code of conduct, compliance and HIPAA policies.
• Performs other duties as assigned by supervisor, management staff or Administrator.

Managed Care Coordinator Educational Requirements and Qualifications

• Minimum of High School Diploma
• 1 2 years of experience within the HMO Managed Care Insurance Companies
• Knowledge of Medicare and Medicaid Managed Care Policies and Utilization Review.

Managed Care Coordinator Skills and Competencies

• Demonstrated proficiency with Microsoft Office
• Bilingual English/Spanish speaking preferred
• This position requires regular interaction with residents, coworkers, visitors, and/or supervisors. In order to ensure a safe work environment for residents, coworkers, visitors, and/or supervisors of the Company, and to permit unfettered communication between the employee and those residents, coworkers, visitors, and supervisors, this position requires that the employee be able to read, write, speak, and understand the English language at an intermediate or more advanced level.

$18.50 - $23.07/Hour

Managed Care Coordinator Overview

The Managed Care Coordinator assists and supports the LPN/RN MDS Coordinator with case management responsibilities. The candidate is the primary liaison between the SNF and the HMO Managed Care Insurance Companies. This includes all types of communication (eFax, email, scan documents, phone calls) with case managers to provide concurrent updates as requested by Insurance Companies, handles Third Party appeals, peer to peers as applicable and with clinical oversight provided by the LPN/RN MDS Coordinator. Attends team meetings at the discretion of the MDS Coordinator.

Managed Care Coordinator Essential Job Functions

• Able to successfully interact with HMO Case Managers in a professional manner.
• Duties include scanning the documents from the EMR after the MDS Coordinator reviews.
• Participate in interdisciplinary team meetings as needed by the MDS Coordinator.
• Understands the organization's quality management program and the care coordinator's role within that program, with compliance of all policies and procedures.
• Maintains privacy, as per policies and procedures within a secure environment of documentation and communication.
• Embraces change; maintains an open mind and is flexible and adaptable in the face of ambiguity and change.
• Utilizes electronic timekeeping system as directed.
• Arrives to work on time, regularly, and works as scheduled.
• Recognizes and follows the dress code of the facility including wearing name tag at all times.
• Follows policy and procedure regarding all electronic devices, computers, tablets, etc.
• Supports and abides by Elderwood's Mission, Vision, and Values.
• Abides by Elderwood's businesses code of conduct, compliance and HIPAA policies.
• Performs other duties as assigned by supervisor, management staff or Administrator.

Managed Care Coordinator Educational Requirements and Qualifications

• Minimum of High School Diploma
• 1 2 years of experience within the HMO Managed Care Insurance Companies
• Knowledge of Medicare and Medicaid Managed Care Policies and Utilization Review.

Managed Care Coordinator Skills and Competencies

• Demonstrated proficiency with Microsoft Office
• Bilingual English/Spanish speaking preferred
• This position requires regular interaction with residents, coworkers, visitors, and/or supervisors. In order to ensure a safe work environment for residents, coworkers, visitors, and/or supervisors of the Company, and to permit unfettered communication between the employee and those residents, coworkers, visitors, and supervisors, this position requires that the employee be able to read, write, speak, and understand the English language at an intermediate or more advanced level.

EOE Statement

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

• Establishing and maintaining direct communication with MCO Foster Care Liaisons and the LDSS to coordinate enrollment when a child/youth is placed with the agency, including enrolling 8D babies born to youth in agency programs.
• Coordination of Services through ongoing interaction between agency program providers and the Fiscal Department.
• Ensuring current information and Insurance Cards are reflected in/uploaded to agency care management system (ASARA)
• Investigating and resolving invoices from care providers by identifying appropriate MCO or insurance plan and facilitating payment.
• Ensuring current information and Insurance Cards are reflected in/uploaded to agency care management system (ASARA)
• Be the primary contact person to the MCOs to assist with ensuring coverage and access to care for the child/youth, including but not limited to:
  • Informing the MCO of and coordinating access to immediately-needed services;
  • Referring children/youth for needed services and assist in provider selection;
  • Responding to MCO and service provider communications
  • Coordinating with health care providers, including school and community-based services;
  • Sharing of plans of care and communicating significant changes in the child/youth's health or functioning, need for additional required/recommended assessments;
  • Assisting with court-ordered services and Fair Hearings;
  • Facilitating single-case agreements if needed when a child/youth is placed outside the MCO's service area;
  • Discharge planning to ensure child/youth leaves care with coverage;
  • Notifying the MCO of changes in residential status or foster care placement, absence from the agency, or other insurance coverage;
  • Consistent reviews to ensure the child's eligibility is maintained;
  • Assist with consent and/or confidentiality issues;
  • With the QI Director of Integrated Health, ensure required documentation for all case actions (clinical notes) are completed within established timeframes.

• Analyze and report on overall financial performance on University Hospital of Brooklyn (UHB) managed care contracts, including risk agreements, such as Healthfirst.
• Prepare reports, track changes in managed care revenue, payer mix, volume, length of stay, case mix and other hospital utilization statistics.
• Track and project UHB's performance in the Healthfirst's risk agreement.
• Support the department's efforts to fully develop the cost-accounting functionality.
• Research, compile, and analyze data to support clinical business plan development, new managed care products and initiatives.
• Be responsible for the daily dashboard.

• Bachelor's Degree in Finance or a related field.
• 5+ years of experience in financial analyst or similar role.
• Advanced Excel skills and experience with financial software (e.g. MedMetrix).
• Excellent analytical and problem-solving abilities.

Job Description - Managed Care Provider Enrollment Specialist (2502668)

Managed Care Provider Enrollment Specialist

Position Summary

At Stony Brook Medicine, as a Managed Care Provider Enrollment Specialist, you will work under the oversight of the Director of Managed Care Enrollment and join a team of professionals representing Stony Brook Medicine* and its Clinical Integrated Network. As a member of the Managed Care Enrollment (MCE) Team, you will be responsible for coordinating and facilitating managed care provider and facility enrollment and network participation activities on behalf of SBM.

*For purposes of this position, Stony Brook Medicine includes the following entities: Stony Brook University Hospital, Stony Brook Children's Hospital, Stony Brook Southampton Hospital, Stony Brook Eastern Long Island Hospital, Stony Brook Clinical Practice Management Plan, Inc., and Meeting House Lane Medical Practice, PC.

Duties of a Managed Care Provider Enrollment Specialist may include the following but are not limited to:

• Responsible for the data intake of SBM providers for the purpose of enrolling a provider in a managed care organization or other payer (MCO) network. Work collaboratively with SBM providers to collect, capture and process the following information: Enrollment Packet with supporting documentation; Department Managed Care checklist; Demographic data; and Participation Information. For MCOs not under a delegated agreement: Complete enrollment applications, paper change forms, eMedNY, PECOS, CAQH profile or other method established by the MCO within time frames required by MCO.
• Coordinate provider enrollment activities to ensure timely provider submissions to MCOs e.g. Delegated/Non-Delegated (CAQH) providers. Notify the MCO of provider demographic/participation statuses. In accordance with the terms of the delegated credentialing agreement, providers are to be enrolled within ninety (60) days of roster submission. Inform Director of Enrollment of MCOs non-compliance. A provider enrollment roster should be sent, at a minimum, once per month to the MCO or as required by the delegated credentialing agreement in place between the MCO and SBM. Upon receipt of the providers participation status, notify key stakeholders of the ID number and effective date. Keep accurate communication records. Upon notice of a change in a providers demographic data, licensure or certification, update delegated credentialing electronic roster for each assigned MCO and email to MCO within twenty-four (24) hours of receipt of demographic change. Upon notice of a providers termination from SBM, update delegated credentialing electronic roster and email to MCO within twenty-four (24) hours of receipt of termination notice. For MCOs not under a delegated agreement: Complete paper change form, CAQH profile or other method established by the MCO within timeframes required by MCO.
• Gather and review data for reporting purposes to meet MCE delegated credentialing contractual obligations. Depending on MCO, monthly, quarterly, semiannual and/or annual reporting of provider database roster reviews are a requirement of the delegated credentialing agreement. Upon notice from the MCO, furnish the report or roster review within the timeframe required by delegated credentialing agreement. At the request of the MCO, review MCOs provider database for accuracy. If incorrect, follow MCOs policy and procedure for reporting incorrect or incomplete information.
• Conduct quality assessments for all databases that are created and/or maintained by MCE. If the findings are unsatisfactory, contact the SBM provider/MCO to discover the reason. Make updates/corrections where possible. Escalate all questions and inquiries to the Director of Enrollment. Maintain the integrity of all MCE databases by continuously auditing the data that is collected and distributed. Communicate effectively with the MCE team and other key stakeholders to gather, assess and resolve inconsistencies. Some examples of data reviews that assist in maintaining the data integrity are as follows: Quarterly Database Review, Internal and External Roster Review, Monthly Expirables Management Review, Service Location Review, Billing Address Review.
• Maintain vital relationships with MCOs by addressing all inquiries in a timely fashion. Work with SBM team members to resolve various inquiry types that are related to provider enrollment. Such as, but are not limited to, the following: Claim denials; Authorization issues; Provider participation inquiries; Transferring of member panel inquiries; and Provider location inquiries. As needed, direct questions and escalations to the Director of Enrollment.
• For non-Clinical Practice provider groups, review, analyze, and report on various data sets deemed necessary by the department. Such as, but not limited to, the following: Database Update Review Tracker and/or Report, MCE Roster Submission Tracker and/or Report, Monthly Status Report.
• Attend, participate and/or facilitate professional development activities. Actively participate in workshops, meetings, training programs and/or other professional activities deemed necessary by the Director of Enrollment.
• Develop and distribute notifications to internal SBM team members. Work collaboratively with MCE Team members to develop and distribute the departmental newsletter(s), and/or other forms of notifications as outlined in departmental workflows and/or advised by the Director of Enrollment. As appropriate, facilitate regularly scheduled meetings with MCOs to build and maintain open lines of communication and to foster collaboration for provider enrollment and facility credentialing/re-credentialing initiatives.
• As it pertains to credentialing, maintain current knowledge of NCQA, TJC, CMS and NYS laws and regulations. Review the following for MCOs: newsletters, policy updates and other notifications that directly affect MCE Team workflow(s). Direct questions regarding revised law, regulatory guidelines and MCO correspondence with the Director of Enrollment.
• Conduct data entry for MCE in Symplr Provider credentialing software. Responsible for the timely processing and tracking of provider enrollment data e.g. Provider ID numbers and Effective Dates. Add, update, and maintain the integrity of the data that is entered into the electronic credentialing database daily. Ensure that all data is current. Escalate all database expirables issues or data integrity issues to the Director of Enrollment.For providers not in Symplr Provider, conduct data entry in applicable electronic database. Add, update and maintain the integrity of the data that is entered into the electronic database. Ensure that all the data is current.
• Coordinates and implements credentialing activities to assist SBM facilities with the completion of MCO facility credentialing/re-credentialing applications for MCO network contract offerings; monitors and follows-up as needed. Conduct data entry for MCE in the electronic database. Responsible for the timely processing and tracking of facility demographic data, including services rendered at each facility location. Add, update, and maintain the integrity of the data that is entered into the electronic facility credentialing database daily. Ensure that all data is current. Conducts provider managed care enrollment and facility credentialing and re-credentialing activities; communicates with practice plan administration or hospital staff to obtain requisite credentialing information to facilitate timely completion and submission of required documents. Escalate all database issues or data integrity issues to the Director of Enrollment.
• Establishes and manages relationships with internal team members as it relates to PCMH.
• Monitors to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards.

Qualifications

Required Qualifications:

• Bachelors Degree
• Minimum of three (3) years of direct experience in enrolling clinical health care providers either within a health care delivery organization or group of moderate or significant size or on behalf of a managed care organization or payer.
• Direct experience with NYS Medicaid and Medicare enrollment and recertification.
• Experience setting up and managing the Council for Affordable Quality Healthcare (CAQH) profiles.
• Knowledge of NCQA, TJC, CMS and New York State Education Department and New York State Department of Health Laws as they pertain to credentialing.
• Demonstrate project management skills and be proficient in database management.
• Demonstrate background in healthcare credentialing policy and management.
• Strong interpersonal and communication skills, proven research and analytical skills, and ability to handle multiple priorities.
• Ability to follow, read and interpret managed care delegated credentialing contracts.
• Proficient in the use of Symplr Provider, Microsoft Office software, and Google software.

Preferred Qualifications:

• MBA, MHP, MPA or equivalent advanced degree.
• Minimum of five (5) years of direct experience enrolling health care providers.
• Minimum of five (5) years of direct experience with managed care enrollment or credentialing and re-credentialing.
• Minimum of five (5) years of direct experience with managed care facility credentialing and re-credentialing.
• Knowledge of medical staff credentialing processes, procedures and resources.

Special Notes : Resume/CV should be included with the online application.

Posting Overview : This position will remain posted until filled or for a maximum of 90 days.An initial review of all applicants will occur two weeks from the posting date. Candidates are advised on the application that for full consideration, applications must be received before the initial review date (which is within two weeks of the posting date).

If within the initial review no candidate was selected to fill the position posted, additional applications will be considered for the posted position; however, the posting will close once a finalist is identified, and at minimal, two weeks after the initial posting date. Please note, that if no candidate were identified and hired within 90 days from initial posting, the posting would close for review, and possibly reposted at a later date.

___

• Stony Brook Medicine is a smoke free environment.Smoking is strictly prohibited anywhere on campus, including parking lots and outdoor areas on the premises.
• All Hospital positions may be subject to changes in pass days and shifts as necessary.
• This position may require the wearing of respiratory protection, which may prohibit the wearing of facial hair.
• This function/position may be designated as essential. This means that when the Hospital is faced with an institutional emergency, employees in such positions may be required to remain at their work location or to report to work to protect, recover, and continue operations at Stony Brook Medicine, Stony Brook University Hospital and related facilities.

Prior to start date,the selected candidate must meet the following requirements:

• Successfully complete pre-employment physical examination and obtain medical clearance from Stony Brook Medicine's Employee Health Services*
• Complete electronic reference check with a minimum of three (3) professional references.
• Successfully complete a 4panel drug screen*
• Meet Regulatory Requirements for pre-employment screenings.
• Provide a copy of any required New York State license(s)/certificate(s).

Failure to comply with any of the above requirements could result in a delayed start date and/or revocation of the employment offer.

*The hiring department will be responsible for any fee incurred for examination .

___

Stony Brook University is committed to excellence in diversity and the creation of an inclusive learning, and working environment. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, pregnancy, familial status, sexual orientation, gender identity or expression, age, disability, genetic information, veteran status and all other protected classes under federal or state laws.

If you need a disability-related accommodation, please call the University Office of Equity and Access at ( .

In accordance with the Title II Crime Awareness and Security Actacopy of our crime statistics can be viewed here .

Visit our WHY WORK HERE page to learn about thetotal rewardswe offer.

Stony Brook University Hospital, consistent with our shared core values and our intent to achieve excellence, remains dedicated to supporting healthier and more resilient communities, both locally and globally.

Anticipated Pay Range:

The salary range (or hiring range) for this position is $93636 - $09242 / year.

The above salary range represents SBUHs good faith and reasonable estimate of the range of possible compensation at the time of posting. The specific salary offer will be based on the candidates validated years of comparable experience. Any efforts to inflate or misrepresent experience are grounds for disqualification from the application process or termination of employment if hired.

Some positions offer annual supplemental pay such as:

• Location pay for UUP full-time positions ( 3400)

Your total compensation goes beyond the number in your paycheck. SBUH provides generous leave, health plans, and a state pension that add to your bottom line.

Official Job Title : TH Senior Staff Assistant

Department/Hiring Area : Medical Center Managed Care

Salary Grade : SL3

Position SummaryAt Stony Brook Medicine, as a Managed Care Provider Enrollment Specialist, you will work under the oversight of the Director of Managed Care Enrollment and join a team of professionals representing Stony Brook Medicine* and its Clinical Integrated Network. As a member of the Managed Care Enrollment ("MCE") Team, you will be responsible for coordinating and facilitating managed care provider and facility enrollment and network participation activities on behalf of SBM.*For purposes of this position, Stony Brook Medicine includes the following entities: Stony Brook University Hospital, Stony Brook Children's Hospital, Stony Brook Southampton Hospital, Stony Brook Eastern Long Island Hospital, Stony Brook Clinical Practice Management Plan, Inc., and Meeting House Lane Medical Practice, PC. Duties of a Managed Care Provider Enrollment Specialist may include the following but are not limited to: Responsible for the data intake of SBM providers for the purpose of enrolling a provider in a managed care organization or other payer ("MCO") network. Work collaboratively with SBM providers to collect, capture and process the following information: Enrollment Packet with supporting documentation; Department Managed Care checklist; Demographic data; and Participation Information. For MCO's not under a delegated agreement: Complete enrollment applications, paper change forms, eMedNY, PECOS, CAQH profile or other method established by the MCO within time frames required by MCO. Coordinate provider enrollment activities to ensure timely provider submissions to MCOs e.g. Delegated/Non-Delegated (CAQH) providers. Notify the MCO of provider demographic/participation statuses. In accordance with the terms of the delegated credentialing agreement, providers are to be enrolled within ninety (60) days of roster submission. Inform Director of Enrollment of MCOs non-compliance. A provider enrollment roster should be sent, at a minimum, once per month to the MCO or as required by the delegated credentialing agreement in place between the MCO and SBM. Upon receipt of the provider's participation status, notify key stakeholders of the ID number and effective date. Keep accurate communication records. Upon notice of a change in a provider's demographic data, licensure or certification, update delegated credentialing electronic roster for each assigned MCO and email to MCO within twenty-four (24) hours of receipt of demographic change. Upon notice of a provider's termination from SBM, update delegated credentialing electronic roster and email to MCO within twenty-four (24) hours of receipt of termination notice. For MCO's not under a delegated agreement: Complete paper change form, CAQH profile or other method established by the MCO within timeframes required by MCO. Gather and review data for reporting purposes to meet MCE delegated credentialing contractual obligations. Depending on MCO, monthly, quarterly, semiannual and/or annual reporting of provider database roster reviews are a requirement of the delegated credentialing agreement. Upon notice from the MCO, furnish the report or roster review within the timeframe required by delegated credentialing agreement. At the request of the MCO, review MCO's provider database for accuracy. If incorrect, follow MCO's policy and procedure for reporting incorrect or incomplete information. Conduct quality assessments for all databases that are created and/or maintained by MCE. If the findings are unsatisfactory, contact the SBM provider/MCO to discover the reason. Make updates/corrections where possible. Escalate all questions and inquiries to the Director of Enrollment. Maintain the integrity of all MCE databases by continuously auditing the data that is collected and distributed. Communicate effectively with the MCE team and other key stakeholders to gather, assess and resolve inconsistencies. Some examples of data reviews that assist in maintaining the data integrity are as follows: Quarterly Database Review, Internal and External Roster Review, Monthly Expirables Management Review, Service Location Review, Billing Address Review. Maintain vital relationships with MCO's by addressing all inquiries in a timely fashion. Work with SBM team members to resolve various inquiry types that are related to provider enrollment. Such as, but are not limited to, the following: Claim denials; Authorization issues; Provider participation inquiries; Transferring of member panel inquiries; and Provider location inquiries. As needed, direct questions and escalations to the Director of Enrollment. For non-Clinical Practice provider groups, review, analyze, and report on various data sets deemed necessary by the department. Such as, but not limited to, the following: Database Update Review Tracker and/or Report, MCE Roster Submission Tracker and/or Report, Monthly Status Report. Attend, participate and/or facilitate professional development activities. Actively participate in workshops, meetings, training programs and/or other professional activities deemed necessary by the Director of Enrollment. Develop and distribute notifications to internal SBM team members. Work collaboratively with MCE Team members to develop and distribute the departmental newsletter(s), and/or other forms of notifications as outlined in departmental workflows and/or advised by the Director of Enrollment. As appropriate, facilitate regularly scheduled meetings with MCO's to build and maintain open lines of communication and to foster collaboration for provider enrollment and facility credentialing/re-credentialing initiatives. As it pertains to credentialing, maintain current knowledge of NCQA, TJC, CMS and NYS laws and regulations. Review the following for MCO's: newsletters, policy updates and other notifications that directly affect MCE Team workflow(s). Direct questions regarding revised law, regulatory guidelines and MCO correspondence with the Director of Enrollment. Conduct data entry for MCE in Symplr Provider credentialing software. Responsible for the timely processing and tracking of provider enrollment data e.g. Provider ID numbers and Effective Dates. Add, update, and maintain the integrity of the data that is entered into the electronic credentialing database daily. Ensure that all data is current. Escalate all database expirables issues or data integrity issues to the Director of Enrollment. For providers not in Symplr Provider, conduct data entry in applicable electronic database. Add, update and maintain the integrity of the data that is entered into the electronic database. Ensure that all the data is current. Coordinates and implements credentialing activities to assist SBM facilities with the completion of MCO facility credentialing/re-credentialing applications for MCO network contract offerings; monitors and follows-up as needed. Conduct data entry for MCE in the electronic database. Responsible for the timely processing and tracking of facility demographic data, including services rendered at each facility location. Add, update, and maintain the integrity of the data that is entered into the electronic facility credentialing database daily. Ensure that all data is current. Conducts provider managed care enrollment and facility credentialing and re-credentialing activities; communicates with practice plan administration or hospital staff to obtain requisite credentialing information to facilitate timely completion and submission of required documents. Escalate all database issues or data integrity issues to the Director of Enrollment. Establishes and manages relationships with internal team members as it relates to PCMH. Monitors to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Qualifications Required Qualifications: Bachelor's Degree Minimum of three (3) years of direct experience in enrolling clinical health care providers either within a health care delivery organization or group of moderate or significant size or on behalf of a managed care organization or payer. Direct experience with NYS Medicaid and Medicare enrollment and recertification. Experience setting up and managing the Council for Affordable Quality Healthcare (CAQH) profiles. Knowledge of NCQA, TJC, CMS and New York State Education Department and New York State Department of Health Laws as they pertain to credentialing. Demonstrate project management skills and be proficient in database management. Demonstrate background in healthcare credentialing policy and management. Strong interpersonal and communication skills, proven research and analytical skills, and ability to handle multiple priorities. Ability to follow, read and interpret managed care delegated credentialing contracts. Proficient in the use of Symplr Provider, Microsoft Office software, and Google software. Preferred Qualifications: MBA, MHP, MPA or equivalent advanced degree. Minimum of five (5) years of direct experience enrolling health care providers. Minimum of five (5) years of direct experience with managed care enrollment or credentialing and re-credentialing. Minimum of five (5) years of direct experience with managed care facility credentialing and re-credentialing. Knowledge of medical staff credentialing processes, procedures and resources. Special Notes: Resume/CV should be included with the online application. Posting Overview: This position will remain posted until filled or for a maximum of 90 days. An initial review of all applicants will occur two weeks from the posting date. Candidates are advised on the application that for full consideration, applications must be received before the initial review date (which is within two weeks of the posting date).If within the initial review no candidate was selected to fill the position posted, additional applications will be considered for the posted position; however, the posting will close once a finalist is identified, and at minimal, two weeks after the initial posting date. Please note, that if no candidate were identified and hired within 90 days from initial posting, the posting would close for review, and possibly reposted at a later date. Stony Brook Medicine is a smoke free environment. Smoking is strictly prohibited anywhere on campus, including parking lots and outdoor areas on the premises. All Hospital positions may be subject to changes in pass days and shifts as necessary. This position may require the wearing of respiratory protection, which may prohibit the wearing of facial hair. This function/position may be designated as "essential." This means that when the Hospital is faced with an institutional emergency, employees in such positions may be required to remain at their work location or to report to work to protect, recover, and continue operations at Stony Brook Medicine, Stony Brook University Hospital and related facilities. Prior to start date, the selected candidate must meet the following requirements: Successfully complete pre-employment physical examination and obtain medical clearance from Stony Brook Medicine's Employee Health Services* Complete electronic reference check with a minimum of three (3) professional references. Successfully complete a 4 panel drug screen* Meet Regulatory Requirements for pre-employment screenings. Provide a copy of any required New York State license(s)/certificate(s). Failure to comply with any of the above requirements could result in a delayed start date and/or revocation of the employment offer.*The hiring department will be responsible for any fee incurred for examination.Stony Brook University is committed to excellence in diversity and the creation of an inclusive learning, and working environment. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, pregnancy, familial status, sexual orientation, gender identity or expression, age, disability, genetic information, veteran status and all other protected classes under federal or state laws.If you need a disability-related accommodation, please call the University Office of Equity and Access at ( . In accordance with the Title II Crime Awareness and Security Act a copy of our crime statistics can be viewedhere. Visit ourWHY WORK HERE page to learn about the total rewards we offer.Stony Brook University Hospital, consistent with our shared core values and our intent to achieve excellence, remains dedicated to supporting healthier and more resilient communities, both locally and globally.Anticipated Pay Range: The salary range (or hiring range) for this position is $93636 - $09242 / year. The above salary range represents SBUH's good faith and reasonable estimate of the range of possible compensation at the time of posting. The specific salary offer will be based on the candidate's validated years of comparable experience. Any efforts to inflate or misrepresent experience are grounds for disqualification from the application process or termination of employment if hired. Some positions offer annual supplemental pay such as: Location pay for UUP full-time positions ( 3400) Your total compensation goes beyond the number in your paycheck. SBUH provides generous leave, health plans, and a state pension that add to your bottom line.