Vice President of Managed Care - University Physicians' Association

Description

The Vice President of Managed Care is responsible for directing and conducting managed care activities for University Physicians’ Association, Inc. (UPA) This position is responsible for: maintaining high standards of the credentialing/enrollment process; maintaining and developing relationships internally and with health plans. This position reports directly to the Chief Operating Officer (COO).

At UPA, we foster a positive and growth-oriented culture, providing an environment where you can learn and thrive. As part of our commitment to being a great workplace for all team members, we offer a comprehensive benefits package, which includes:

• Medical, Dental, and Vision Insurance
• 401(k) with company match and immediate vesting
• Short-term and Long-term Disability
• Life Insurance
• Critical Illness Coverage
• Flexible Spending Accounts
• Health Savings Account with Employer Contribution
• Paid Time Off (PTO), Sick Leave, and Bereavement Leave
• Employee Assistance Program
• Access to Fitness Center
• And more!

Position Type

This is a full-time position. Days of work are Monday through Friday. Hours worked are typically anywhere between 7:00 a.m. to 6:00 p.m. Evening and weekend work may be required as workload demands. This position offers hybrid work opportunities but requires some in office availability. The ideal candidate would be local to the Knoxville or surrounding areas.

Essential Functions

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Oversee the staff and daily operation of the Managed Care and Essential Services departments within UPA.

2. Maintain strong relationships with external payors and credentialing partners to ensure compliance with all requirements.

3. Develop and enhance relationships with internal and external contacts. Proactively plan, prioritize, and communicate regarding projects, issues, to ensure relationships are maintained and UPA’s values are demonstrated on a day-day basis and when difficult business decisions need to be made.

4. Continuously improve credentialing systems and processes, leveraging automation and technology to enhance efficiency.

5. Lead and coordinate activities of personnel in the performance and management of existing managed care and membership duties.

6. Represent UPA in meetings with other organizations, associations, providers and payors regarding aspects of managed care. Serve in a lead role within UPA regarding managed care activities.

7. Ability to create and enforce credentialing policies while ensuring alignment across departments.

8. Strong leadership, communication, and problem-solving skills.

9. High attention to detail and the ability to manage multiple priorities effectively.

Supervisory Responsibility

1. This position is responsible for the direct supervision of team members within the department.

2. Ensure the maintenance of comprehensive current correspondence and provider contact information relating to managed care.

3. Ensure that all credentialing and departmental actions follow the NCQA regulations/guidelines.

4. Oversee Managed Care credentialing and Managed Care delegation audit process.

Requirements

Required Education and Experience

• Bachelor’s degree required, Master’s degree preferred
• Minimum of 10 years of credentialing experience, including leadership in a healthcare setting.
• Strong expertise in compliance, provider enrollment, and onboarding processes.

Travel

This position may require some travel for meetings, seminars and any other off site work functions. Travel is primarily local during the business day, although some out-of-the-area and overnight travel may be expected.

EEO Statement

UPA will provide equal employment opportunity without regard to race, color, religion, gender, national origin, age, disability, genetic information, or status as a covered veteran. This policy applies to recruitment, hiring, training and development, promotion, transfer, termination, layoff, compensation, benefits, leaves of absence and all other conditions and privileges of employment in accordance with applicable federal and state laws.