Position Summary

 

As an academic medical center with a rich history of providing life-saving treatment in Southern Nevada, UMC serves as the anchor hospital of the Las Vegas Medical District, offering Nevada’s highest level of care to promote successful medical outcomes for patients.

We are home to Nevada's ONLY Level I Trauma Center, Designated Pediatric Trauma Center, Burn Care Center, and Transplant Center. We are a Pathway Designated facility by ANCC, and we are on our journey to Magnet status.

Position Summary:
Oversees the management and coordinates actions for provider credentialing, licensure, and ambulatory clinic privileges activities. The position also oversees the day-to-day management of the contract implementation and negotiations of a wide range of agreements with Managed Care Organizations to include Commercial, Medicare and Medicaid products; develops and implements managed care contracting and reimbursement policies for the organization; and ensures contracts comply with legal and regulatory requirements and meets the organization’s financial and strategic goals.

Job Requirement

Education/Experience:
Equivalent to a Bachelor’s Degree in public or business administration or related field and five (5) years of professional level experience in managed care, credentialing, payor enrollment operations, or health care program management, three of which were in a management role.Licensing/Certification Requirements:
None.

Knowledge, Skills, Abilities, and Physical Requirements

Knowledge of:
UMC policies and procedures as they apply to Primary and Quick Care Units and specialty clinics; managed care terminology; supervisory principles and practices; credentialing and privileging; marketing principles and practices; Federal, state and county laws and regulations related to the health care agency; principles of contract law and methods and practices of drafting contracts and agreements; basic data sampling and statistical analysis techniques; computer applications related to duties; department and hospital safety practice and procedures; patient rights; age specific patient care practices; infection control policies and practices; handling, storage, use and disposal of hazardous materials; department and hospital emergency response policies and procedures.Skill in:
Carrying assigned project(s) through, from data gathering to completion; using initiative and independent judgement within general policy guidelines; use of computer software/applications related to duties; developing contractual relationships; updating and attesting provider information through CAQH centralized system; negotiating contracts for services; maintaining accurate records and files; developing public relations; interpreting regulations; communicating effectively with medical professionals concerning a variety of matters; preparing clear and concise reports, correspondence and other written materials; contributing effectively to the accomplishment of team or work unit goals, objectives and activities; using computers and related software applications; communicating with a wide variety of people from diverse socio-economic and ethnic backgrounds; establishing and maintaining effective working relationships with all personnel contacted in the course of duties; efficient, effective and safe use of equipment.

Physical Requirements and Working Conditions:
Mobility to work in a typical office setting and use standard office equipment, stamina to remain standing for long periods of time, vision to read printed materials and a computer screen, and hearing and speech to communicate in person and over the telephone. Strength and agility to occasionally lift and carry up to 25 pounds. Attend meeting outside of normal work hours. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this classification.

Agency University Medical Center of Southern Nevada

Address University Medical Center of Southern NevadaLas Vegas, Nevada, 89102

Website http://www.umcsn.com