Associate Medical Director, Regulatory Management

📋 Description

• Build and lead the Clinical Policy Compliance team and the Clinical Coding Center of Excellence
• Direct the development of clinical regulatory policies, Benefit Interpretation Policies (BIPs), and
• Chair the Credentialing, Peer Review, and Population Health Management sub-committee, driving
• Oversee practitioner and facility credentialing to guarantee compliance with NCQA standards, CMS
• Partner with Network and Market Management executives to accelerate provider onboarding and
• Collaborate on Quality Improvement for Clinical Review Operations, optimizing Inter-Rater

🎯 Requirements

• 7+ years of progressive healthcare experience, including leadership responsibility.
• 3+ years experience managing provider credentialing within a health plan, managed care
• 3+ years knowledge of NCQA credentialing standards, CMS health plan regulatory requirements, and
• 1+ years experience managing and working with clinical coding taxonomies.
• Demonstrated experience leading operational improvement initiatives and managing cross-functional
• Strong knowledge of provider data management, credentialing systems, and primary source

🎁 Benefits

• Base pay: $216,108 - $283,642 per year
• Employee benefits including medical, dental, and vision insurance
• 11 paid holidays
• Paid sick time
• Paid parental leave
• 401(k) plan participation