As the Manager of Clinician Services, you will lead the team responsible for all credentialing, privileging, licensing, and peer review activities. You will set strategic goals and operational plans to ensure efficient and compliant processes. This role is critical as you drive continuous process improvement and achieve significant efficiency gains within clinician services. You will also ensure compliance with NCQA standards and delegated credentialing agreements for various health plans. You will collaborate with the Included Health Credentialing Committee, Clinician Review Committee, Compliance Department, and Quality Department. This is a remote, exempt position reporting to the Director of Clinician Services.
Responsibilities
You will oversee day-to-day operational credentialing, privileging, and licensing activities, collaborating with the Credentialing Committee, Clinician Review Committee, and Clinical Operations team.
You will provide strategic and operational oversight of the clinician peer review process, serving as the primary liaison and collaborative partner to the Chair of the Clinician Review Committee.
You will partner with Go-To-Market and Enrollment teams to develop and implement standardized processes for new customer and payer initiatives.
You will champion and lead initiatives to drive significant process improvement and operational efficiencies across all areas of clinician services.
You will conduct regular workflow analysis to identify bottlenecks, redundant steps, and areas for automation, implementing solutions that enhance productivity and reduce operational costs.
You will establish and monitor key performance indicators (KPIs) related to efficiency, using data to inform continuous improvement efforts and demonstrate tangible gains.
You will manage the selection and management of staff while fostering a culture aligned with IH's core values.
You will ensure credentialing processes are in compliance with NCQA, state, and federal regulatory requirements and delegated credentialing agreements.
You will provide oversight of the clinical supervision/collaboration program and partner with the Compliance and Clinical leadership team to ensure ongoing compliance with state-specific regulations.
You will maintain oversight of ongoing monitoring, compliance, and re-certification activities for accrediting organizations.
You will identify, prioritize, and implement workflow and technology/product enhancements to improve licensing and credentialing efficiencies and clinician satisfaction.
You will analyze, report, and present recommendations on various key metrics and trends related to the clinician onboarding process and credentialing/licensing.
You will participate in and present recommendations around strategic planning and annual goal setting.
You will monitor and manage the allocated budget for Clinician Services operations, ensuring cost-effectiveness and resource optimization.
Qualifications
Bachelors Degree
Minimum of 5 years of experience in Medical Staff Services with at least 3 years in a people management role
Strong people management and motivational skills
Excellent verbal and written communication skills
Excellent interpersonal skills and ability to interface effectively across multiple teams
Excellent time management skills with a proven ability to meet deadlines
Ability to drive teams' results and prioritize their activities in alignment with business objectives
Strong analytical and problem-solving skills
Ability to function well in a high-paced environment and able to quickly adapt to change
About Included Health
Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We’re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community — no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It’s all included. Learn more atincludedhealth.com.
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Included Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Included Health considers all qualified applicants with arrest or conviction records in accordance with the San Francisco Fair Chance Ordinance, the Los Angeles County Fair Chance Ordinance, and California law.
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