CPCS / CPMSM Managed Care Senior Project Manager (Remote) Job Listing at Mercy in Chesterfield, MO (Job ID 939565)

Description

We're a Little Different

Our mission is clear. We bring to life a healing ministry through our compassionate care and exceptional service.

At Mercy, we believe in careers that match the unique gifts of unique individuals – careers that not only make the most of your skills and talents, but also your heart. Join us and discover why Modern Healthcare Magazine named us in its “Top 100 Places to Work.”

Overview: CPCS or CPMSM Managed Care Senior Project Manager (Remote)

The Managed Care Senior Project Manager supports the ongoing operational strategies of the Managed Care department. In partnership with functional leaders, the Senior Project Manager is responsible for driving business readiness activities across multiple teams to ensure timely, high-quality implementation of new products, product expansions or major initiatives within Managed Care. This role will include being responsible for managing projects and implementations as assigned in order to maximize the efficiency of the Managed Care department. This involves collaboration with departments across the Ministry and escalating issues and concerns accordingly. Performs duties and responsibilities in a manner consistent with our mission, values, and Mercy Service Standards.

Qualifications:

• Experience: 5+ years' experience in health care, preferably in managed care, can be either provider or health plan. 2-5 years Program and/or project management experience
• Required Education: Bachelor's degree.Master's/graduate degree preferred

• Certifications:

  • Certified Provider Credentialing Specialist (CPCS): Preferred or within three years on the job.
  • Certified Provider Medical Staff Management (CPMSM): Preferred or within five years on the job

   

   

• Core Functions:

  • Oversee outreach to primary sources for practitioners' information, ensuring staff are accurately obtaining and evaluating information from primary sources.
  • Determine applicant's initial eligibility for membership/participation based on approved criteria.
  • Support NCQA accreditation process and maintenance of accreditation once approved.
  • Oversees delegation process.
  • Oversee the department's participation in surveys and audits of regulatory and accreditation agencies or organizations.
  • Oversee the monitoring and reporting of sanctions and complaints for all practitioners/providers to inform and recommend action by organizational leadership.
  • Advanced understanding of state, federal, and regulatory standards. Update applicable governing documents (policies and procedures) that support and direct organizational practices and ensure compliance.
  • Audit, assess, procure, implement, effectively utilize and maintain practitioner/provider credentialing processes and information systems (e.g., files, reports, minutes, databases) by analyzing the needs and resources of health plans/credentialing.
  • Foster a team-dynamic and cohesive, collaborative department with an entirely remote workforce.

   

   

• Other:

  • Proficient in Microsoft Office Products
  • Proficient with Symplr or comparable credentialing systems is preferred.

We Offer Great Benefits:

Day-one comprehensive health, vision and dental coverage, PTO, tuition reimbursement and employer-matched retirement funds are just a few of the great benefits offered to eligible co-workers, including those working 32 hours or more per pay period!

We're bringing to life a healing ministry through compassionate care.

At Mercy, our supportive community will be behind you every step of your day, especially the tough ones. You will have opportunities to pioneer new models of care and transform the health care experience through advanced technology and innovative procedures. We're expanding to help our communities grow. Join us and be a part of it all.

What Makes You a Good Match for Mercy?

Compassion and professionalism go hand-in-hand with us. Having a positive outlook and a strong sense of advocacy is in perfect step with our mission and vision. We're also collaborative and unafraid to do a little extra to deliver excellent care – that's just part of our commitment. If that sounds like a good fit for you, we encourage you to apply.

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