What are the responsibilities and job description for the Director, Credentialing SCO and OneCare position at C3?
Title: Director, Credentialing SCO and OneCare
Reports to: Vice President, Operations
Classification: Director
Location: Boston, MA (Hybrid)
Job description revision number and date: V2.0; 3/31/2025
Organization Summary:
Community Care Cooperative (C3) is a 501(c)(3) non-profit, Accountable Care Organization (ACO) governed by Federally Qualified Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We are a fast-growing organization founded in 2016 with 9 health centers and now serving hundreds of thousands of beneficiaries who receive primary care at health centers and independent practices nationally. We are an innovative organization developing new partnerships and programs to improve the health of members and communities, and to strengthen our health center partners.
SCO and One Care Summary:
The Senior Care Options (SCO) and One Care programs are health plan programs for dually eligible
(Medicare and Medicaid) individuals (“duals”) in Massachusetts. SCO serves eligible beneficiaries aged 65 , while One Care serves duals between ages 21-64. These programs are Fully Integrated Dual- Eligible Special Needs Plans (FIDE-SNP) that integrate Medicare and Medicaid benefits, along with additional supports for enrollees such as integrated care teams, care managers, social supports, etc.
Massachusetts’ Medicaid (MassHealth) agency recently conducted a procurement for health plans to offer products in these two programs, for a five-year term starting January 1, 2026. C3 submitted a bid and was selected in September 2024.
Job Summary:
Under the direction of the VP of Operations and in partnership with the Provider Network team and credentialing vendor, the Director of Credentialing will be responsible for overseeing the entire credentialing and provider enrollment process, ensuring compliance with regulations and standards, and managing a growing team of credentialing specialists. The Director will be responsible for standing up a credentialing team in a start-up environment, participate in NCQA Health Plan Accreditation activities, and develop required policies and procedures.
Responsibilities:
- Responsible for overseeing the credentialing vendor who is contracted to do end-to-end credentialing for SCO/One Care providers
- Develop and execute strategies for efficient and accurate provider enrollment and credentialing processes, in collaboration with Provider Network leadership
- Develop a Credentialing Committee and associated workflows and policies for the committee
- Participate in NCQA Accreditation activities and is responsible for meeting credentialing and re- credentialing standards and guidelines
- Ensure compliance with the State and Federal regulations
- Complete reports based on requirements and organizational needs
- Supports data collection and flow as necessary
- Oversee, lead, and build a team of credentialing specialists
- Other responsibilities as assigned
Required Skills:
- Management/supervisory experience in a healthcare field, 5 years
- Strong knowledge of credentialing regulations and standards
- Experience with and knowledge of CAQH and credentialing processes
- Experience and knowledge of NCQA standards and guidelines
- Meticulous orientation to details and ability to handle multiple concurrent assignments
- Excellent written and oral communications including the ability to present complex situations in a clear and concise manner
- Experience working in a fast-paced environment
- Proficiency in credentialing software and data management systems
- Collaborative, flexible, innovative
- Strategic thinking and the ability to implement efficient processes
Desired Other Skills:
- Familiarity with SCO/OneCare
- Experience with anti-racism activities, and/or lived experience with racism is highly preferred
Qualifications:
- 7 years of credentialing experience required
- Certified Provider Credentialing Specialist (CPCS) required
** In compliance with Covid-19 Infection Control practices per Mass.gov recommendations, we require all employees to be vaccinated consistent with applicable law. **
