Correctional Medicine Credentialing Specialist - Managed Care Needed in Nashville, TN

Company: WellPath
Location: Nashville
Posted on: January 14, 2021

Job Description:

Correctional Medicine opening in Nashville, Tennessee. This and other clinical nurse specialist jobs brought to you by NursingJobCafe.com Here at Wellpath, everything that we do is about taking care of people - our patients, our staff and our partners. We are committed to making a difference by providing hope and healing to vulnerable patients in challenging clinical environments. Our talented, compassionate team thrives in an autonomous environment, is empowered and supported by education, training and the resources to practice healthcare the way it is meant to be and strives to "Always Do The Right Thing!"Our Credentialing Specialist reviews and legally researches applications for potential providers and oversees approval process. Our Credentialing Specialist is also responsible for all aspects of creating and maintaining the credentials for all mid-level and above providers of patient care at all company facilities and maintains up-to-date data for each provider in the credentialing databases, ensuring timely renewal of licenses for the company.Education:

• High School Diploma or equivalent, required
• Some College, preferredExperience:
  • Proficient in Microsoft Office.
  • Sound decision-making skills are mandatory.
  • Ability to multi task in a fast paced environment with focus on timelineness, documentation and communication with peers and potential providers.Licenses/Certifications:
    • None required
    • Manage provider credentialing process, including making decisions, to meet time-sensitive deliverables and necessity of further investigations for applicants.
    • Create and maintain credentialing and re-credentialing applications for process review by clinical leadership. Advises and recommends new credentialing process for acquisitions.
    • Organize and maintain provider credentialing and re-credentialing files, as well as inactive provider files.
    • Update and maintain credentialing database to continuously monitor provider document expirations and generate monthly reports to all facilities.
    • Create and distribute reports on credentialing activities.
    • Conduct file audits and summarize findings. Make recommendations regarding any adverse findings.
    • Review credentialing information and processes on an on-going basis to identify possible process improvements.
    • Ensure that all credential files are current and complete pursuant to expiration date of medical license, DEA and other pertinent information.
    • Assure confidentiality of data.
    • Work with outside CVO firm on applications that require immediate background investigation upon determination that further investigation is necessary.
    • Review credentialing invoice and process monthly payment to outside CVO firm.
    • Manage provider requests process; receive requests for applications; compile application documents and send to potential provider for completion.
    • Upon receipt of application, review for completeness of information, identify deficiencies and pursue incomplete information.
    • Compile, evaluate, and present the complete application and documents to CMO for approval.
    • Recognize and investigate discrepancies and adverse information obtained from the application and primary source verification to ensure that review and approval bodies have the information needed to make informed credentialing decisions.
    • Present the complete application and documents to outside CVO firm for in-depth investigation based on decisions that certain issues need further inquiry.
    • Receive and track all applications and correspondence and maintain documentation as required.
    • Must be able to apply principles of critical thinking to a variety of practical and emergent situations and accurately follow standardized procedures that may call for deviations.
    • Must be able to apply sound judgment beyond a specific set of instructions and apply knowledge to different factual situations.
    • Must be alert at all times; pay close attention to details.
    • Must be able to work under stress on a regular or continuous basis.
    • Perform other duties as assigned.Wellpath is an EOE/Minorities/Females/Vet/Disability Employer Keyphrases: correctional medical services jobs, correctional medicine jobs, correctional health services jobs, prison health services jobs

Keywords: WellPath, Nashville , Correctional Medicine Credentialing Specialist - Managed Care Needed in Nashville, TN, Healthcare , Nashville, Tennessee