We’re a collaborative, purpose-driven group that’s passionate about transforming healthcare from the inside out. At Altais, we support one another, adapt quickly, and work with integrity as we build a better experience for physicians and their patients.
This role is responsible for the strategic direction and operational oversight of the credentialing function to support, develop, manage and monitor processes and procedures for the credentialing, re-credentialing, expirables data management and delegated functions for all our Health Plan Partners for all lines of business. This role manages the credentialing program for Altais affiliated entities, including employed clinicians, vendors providing clinical services on the MSOs behalf, as well as MSO services for any other medical group or IPA purchasing from Altais Health Solution including application management and primary source verification completion. This role is also responsible for the administrative aspects for all credentialing functions needed to meet medical group, health plan and accrediting body requirements including but not limited to the National Committee for Quality Assurance (NCQA), the Centers for Medicare & Medicaid Services (CMS), and the Department of Managed Health Care (DMHC). This role, in combination with the Credentialing team, is to maintain procedures, processes and internal & vendor systems in line with all regulation and compliance requirements. This role has key vendor management oversight responsibilities to ensure our contracted vendor systems and services are delivering services and capabilities as expected. Additionally, this role will oversee the interdependencies between departments, consistently maintaining knowledge and understanding of the impact to providers and how that may affect overall business operations and financial outcomes. At the senior level, this role owns the credentialing policy portfolio, the development and maintenance of departmental training documentation, preparation and facilitation of the Credentialing Committee, pre-delegation and ongoing oversight audits of sub-delegated entities, and the development of key performance indicators and executive reporting for the function.