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About the Role

Oversee the Credentialing Verification Organization (CVO) and ensure the delivery of credentialing services, including production, quality audit, reporting, ongoing monitoring, and process improvement. Maintain and validate credentialing data for all network providers across multiple lines of business to ensure a compliant and quality network for Aetna members. Align departmental policies and procedures with organizational goals, delivering on financial, operational, and service requirements while leading managers and vendors.

Responsibilities

Oversee operational management of Commercial, Medicare, Medicaid credentialing operations, and ongoing provider monitoring.
Manage a team of approximately 100 employees through multiple managers.
Oversee on-shore and off-shore vendor support for business operations, aligning resources for inventory management and monitoring partner performance.
Contribute to planning and administration of company programs and initiatives for the Credentialing Operations agenda.
Accountable for department initiatives and objectives in partnership with stakeholders and leadership.
Implement organizational policies, goals, and objectives based on best practices.
Build and develop a strong functional operations management team through training, diverse assignments, coaching, and performance management.
Mentor team members to foster talent strategy and succession planning.
Cultivate and manage relationships with various internal business partners.
Ensure consistent execution of Credentialing policies and procedures across the business operation.
Support alignment with accreditation agencies and regulatory bodies.
Administer audit procedures for accurate and compliant provider credentialing data.
Explore solutions with automation, bots, AI, and other tools to drive performance.
Create and deliver process improvement strategies to meet organizational vision and commitments.
Drive change management to support a competitive and changing environment.
Lead integration and administration of credentialing databases, software, and data sources.
Create strategies for continuous improvement of credentialing systems.
Control resources to deliver financial results within established budget parameters.

Requirements

7+ years of directly related experience in Healthcare Operations with a production focus.
Adept at execution and delivery (planning, delivering, and supporting) skills.
Advanced working knowledge of business systems, applications, and tools supporting credentialing, provider data, and inventory management.
Proven ability to work collaboratively at all levels.
Ability to effect change.
Exercises sound judgment and demonstrates analytical/data-driven decision-making skills.
Experience in a matrixed environment which includes outsourcing to external vendors.
Project management experience.

Work Type

Full-time

Education Level

Bachelor's degree or equivalent work experience

Salary/Compensations

$100,000.00 - $231,540.00

Benefits

Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs

About the Company

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience.
At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do.
Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Equal Opportunity

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.