Note: The job is a remote job and is open to candidates in USA. Yale University is a prestigious institution that has established Yale Health to provide health services to its community. The Credentialing & Provider Enrollment Program Manager will oversee the credentialing and privileging program, ensuring compliance and continuous improvement while collaborating with various departments to enhance provider onboarding and management.
Responsibilities
- Collects, verifies and maintains provider and non-licensed professional’s credentials, including licensure, board certifications, training, and other required documentation
- Own and operate the delegated credentialing program end-to-end, including provider onboarding, primary source verification, maintaining alignment with industry quality standards
- Establishes and maintains an effective means of communication internally and externally with clinical leaders, operational teams, regulatory entities and other sources in order to obtain required information for the Yale Health credentialing and privileging application processing
- Maintains credentialing databases and systems, ensuring data integrity, accuracy, and alignment with workflows and reporting needs. Ensures alignment between regulatory requirements, credentialing processes, and system functionality (e.g., Workday Training, credentialing platforms)
- Monitors, tracks and reports on all provider licenses, certifications and registrations, ensuring continuous compliance and timely renewals. Escalates risk as appropriate
- Supports the internal credentialing committee — presenting cases, maintaining meeting minutes, and managing approvals and denials
- Manage internal audits to ensure ongoing credentialing quality and delegated credentialing compliance
- Ensure regulatory readiness with ability to quickly pivot, escalating risks as appropriate
- Set and drive long-term credentialing strategy, partnering with Yale Medicine and Yale New Haven Health System, Human Resources and other central departments to expand delegated credentialing statuses
- Partner with Finance & Business Strategy to align on KPIs and incentive structure, to troubleshoot issues and credentialing-related denials
- Identify and implement process improvements that increase team efficiency, including automation and AI-enabled workflows in accordance with Yale University’s AI Governance guidelines
- Manage the transition of all paper-facing processes to the department’s contracted computer based-solution, leveraging technology to enhance departmental workflows, reduce errors, ensure timeliness and compliance
- Develop and maintain monitoring dashboards and ad-hoc reports with the YH Analytics team as appropriate
- Oversee day-to-day network provider enrollment across group and individual submissions, ensuring timely, accurate, and compliant applications tracked in the department’s contracted, web-based, electronic solution
Skills
- Bachelor's degree in a related field and four years of related experience or an equivalent combination of education and experience
- Demonstrated ability to manage staff and develop specific short- and long-term objectives for staff, with strong interpersonal skills to develop and lead a cohesive team
- Strong communication and presentation skills, with the ability to engage and influence stakeholders at all levels
- Demonstrated experience in healthcare regulatory compliance, credentialing, privileging, and provider enrollment, with comprehensive knowledge of healthcare regulatory requirements, credentialing and privileging standards, and compliance frameworks
- Strong knowledge of relevant guidelines, regulations, and standards (e.g., Good Clinical Practice, IT policies, facilities management protocols)
- Demonstrated ability to identify compliance risks and recommend practical, preventative solutions
- Proven ability to handle complex issues with sound judgment, take initiative, and provide timely resolution
- Analytical and detail-oriented with the ability to manage multiple priorities and meet deadlines
- Well-developed organizational, planning, problem-solving, and communication skills, with attention to detail and the ability to multitask in a fast-paced environment
- Advanced computer skills, including proficiency with Microsoft Office applications and the ability to learn new systems quickly
- Ability to work independently and collaboratively in a highly regulated environment
- Demonstrated a self-starter with the ability to work independently
- High level of integrity, accountability, and professional judgment
- Ability to ensure confidentiality, security and maintenance of sensitive information
- Master's Degree in related field or equivalent combination of education and experience, with minimum three years of experience
- Experience with Workday Training, VerityStream, or similar credentialing and compliance systems
- Experience working with regulatory/accrediting bodies (e.g., CMS, Joint Commission, state agencies, NCQA)
Benefits
- Full-Time Remote (required to be on-site quarterly or as need based of organizational needs)
- Pre-employment background screening for this position, which may include motor vehicle, DOT certification, drug testing and credit checks based on the position description and job requirements
- Healthcare workers (HCW) have specific health requirements that must be met prior to starting work, including MMR vaccine or immunity, varicella (chickenpox) vaccine or immunity, TB screening, COVID vaccine according to University policy, hepatitis B vaccine or immunity, and annual flu vaccination
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