Job Summary:


Oversees and removes barriers to resolve issues during the reviews and requests for primary source information and verifications to focus on long-term needs. Enables relationships for collaboration with external entities. Proactively identifies, suggests improvements to, and provides resolution for complex gaps in vendor relationships. Determines expectations for collaborations to disseminate practitioner information during application process. Evaluates applications and supporting highly complex documents. Oversees and provides consultative efforts on complex cases regarding implementation of guidelines and requirements. Leads definition of credentialing and privileging process for all practitioners/providers. Oversees alignment of organization-wide priorities to evaluate adverse data. Drives adherence to establish priorities when facilitating efficient cost-effective due process. Provides guidance to evaluate data inconsistency. Oversees and removes barrier...