Manager, Credentialing

What we do here changes the world. UTHealth Houston is Texas’ resource for healthcare education, innovation, scientific discovery, and excellence in patient care. That’s where you come in.

Once you join us you won't want to leave. It’s because we reward our team for the excellent service they provide. Our total rewards package includes the benefits you’d expect from a top healthcare organization (benefits, insurance, etc.), plus:

• 100% paid medical premiums for our full-time employees
• Generous time off (holidays, preventative leave day, both vacation and sick time – all of which equates to around 37-38 days per year)
• The longer you stay, the more vacation you’ll accrue!
• Longevity Pay (Monthly payments after two years of service)
• Build your future with our awesome retirement/pension plan!
  
  

We take care of our employees! As a world-renowned institution, our employees’ wellbeing is important to us. We offer work/life services such as...

• Free financial and legal counseling
• Free mental health counseling services
• Gym membership discounts and access to wellness programs
• Other employee discounts including entertainment, car rentals, cell phones, etc.
• Resources for child and elder care
• Plus many more!
  
  

Position Summary:

Plans, coordinates, and directs the business management and administrative activities for the credentialing and provider service functions of the department. Coordinates and monitors the primary source verification process for all credentialed physicians and allied health professionals.

Position Key Accountabilities:

• Direct all Credentialing, Provider Data, and Delegated Credentialing functions while managing the daily operations of the department including training and supervision of staff.
• Provide oversight and guidance to the Credentialing team to assure all timelines, accuracy of data and work processes are met. Assure all health plan, Federal and State reporting requirements are met.
• Perform pre-delegation and annual delegation oversight audits by contracted health plans, ensuring the overall areas for delegation are functional and in compliance with the plans’ regulatory requirements.
• Responsible for credentialing, provider service, business management, and administrative activities which include fiscal and budgetary affairs, personnel matters, operational systems, and other activities essential to the effective operations.
• Maintains NCQA accreditation and has a full understanding and ability to apply NCQA regulatory standards for both quality and credentialing ensuring complete compliance with regulations at all times.
• Coordinates activities of the Credentialing Committee and has frequent contacts with faculty members of the University and maintains work relationships within the Health Science Center, University, and contacts outside UT Physicians as they relate to the department’s functions of credentialing and provider services.
• Responsible for contract review regarding delegated credentialing and provider service functions ensuring compliance is achieved. Responsible for keeping up-to-date with current regulations from TDI, TDH CMS and NCQA as they relate to provider service and credentialing functions. Develops and provides statistical data on credentialed providers for monthly reporting to health plans.
• Manages Human Resources activities for direct reports in regards to: recruiting and selection, hiring and termination, training, professional development, mentoring, counseling, performance evaluations, and salary planning.
• Performs other duties as assigned.
  
  

Certification/Skills:

Excellent written and verbal communication skills. Proficiency with Microsoft Office applications. Experience with one or more credentialing software platforms.

Minimum Education:

Bachelor’s degree or an equivalent combination of education and experience in lieu of the degree.

Minimum Experience:

Five (5) years of experience in provider credentialing. May substitute required experience with equivalent years of education beyond the minimum education requirement.

Physical Requirements:

Exerts up to 20 pounds of force occasionally and/or up to 10 pounds frequently and/or a negligible amount constantly to move objects.

Security Sensitive:

This position is a security-sensitive position pursuant to Texas Education Code

• 51.215 and Texas Government Code
• 411.094. To the extent that a position requires the holder to research, work on, or have access to critical infrastructure as defined in Texas Business and Commerce Code
• 117.001(2), the ability to maintain the security or integrity of the infrastructure is a minimum qualification to be hired for and to continue to be employed in that position. Personnel in such positions, and similarly situated state contractors, will be routinely reviewed to determine whether things such as criminal history or continuous connections to the government or political apparatus of a foreign adversary might prevent the applicant, employee, or contractor from being able to maintain the security or integrity of the infrastructure. A foreign adversary is a nation listed in 15 C.F.R.
• 791.4. Residency Requirement:
  
  

Employees must permanently reside and work in the State of Texas.