What Managed Care contributes to Cardinal Health

Practice Operations Management oversees the business and administrative operations of a medical practice.

Managed Care oversees the interactions that take place between payer and provider(s) to ensure optimal reimbursement including managed care contracting, enrollment, credentialing, and any other activity as it relates to payer interaction.

Job Purpose:

The position is responsible for managing the credentialing/enrollment team and ensuring an active status with all contracted payors for all groups and providers. The position is also responsible for ensuring licensure is updated and active for all groups, providers, and facilities.

Responsibilities:

• Supervises day-to-day credentialing/enrollment operations, including assigning and balancing workloads across the team, reviewing work output for accuracy and completeness, and providing timely feedback and coaching to team members. Responsible for identifying performance gaps and escalating unresolved issues to manager.
• Responsible for documenting and tracking all credentialing, re-credentialing, provider enrollment, and hospital privileging activities within the credentialing software environment.
• Assists new providers with obtaining required clinical licenses and coordinates the full cycle onboarding and enrollment into Medicaid, Medicare, and the commercial insurance plans.
• Develops, documents, and maintains standard operating procedures (SOPs) for all credentialing and enrollment workflows, including provider onboarding. Ensures SOPs are current, accessible to team members, and updated when processes or platforms change. Conducts periodic reviews of existing procedures and recommends improvements to manager.
• Conducts regular quality audits of team members' credentialing and enrollment work, documenting findings, and implementing corrective actions. Maintains audit cadence and reports results to manager.
• Plans and delivers training for new and existing team members on credentialing/enrollment workflows, platform functionality, payer requirements, and departmental SOPs. Coordinate with platform subject matter resources for system-specific training content. Maintains training documentation and tracks completion.
• Serves as the first point of escalation for credentialing and enrollment issues that cannot be resolved at the coordinator level. Triages, tracks, and resolves or escalates issues to manager within documented timeframes.
• Maintain and monitor all licenses and certifications in the database to ensure compliance.

Qualifications:

• At least five (5) years of experience of credentialing experience in a managed care or provider setting, including experience using a credentialing database preferred
• Demonstrated personnel leadership (remote and onsite), provider enrollment technical expertise, effective and professional communication, disciplined execution of strategic initiatives, and relationship management preferred
• Specific knowledge of the payer environment and payer issues, particularly billing and collections.
• Strong knowledge of the rules/regulations of Medicare/Medicaid and other government payors, as well as commercial insurers and specialty contracts to ensure accurate and timely billing and payment of claims.
• Ability to work a flexible schedule (including overtime, and weekends), as necessary.
• Excellent customer service and communication skills.
• Ability to work independently and as part of a team.
• Working experience with Excel spreadsheets and Microsoft Word documents.

What is expected of you and others at this level:

• Coordinates and supervises the daily activities of operations or business staff
• Administers and exercises policies and procedures
• Ensures employees operate within guidelines
• Decisions have a direct impact to work unit operations and customers
• Frequently interacts with subordinates, customers, and peer groups at various management levels
• Interactions normally involve information exchange and basic problem resolution
   

Anticipated salary range: $ 80,900K - 133,980K USD Annual

Bonus eligible: No

Benefits: Cardinal Health offers a wide variety of benefits and programs to support health and well-being.

• Medical, dental and vision coverage
• Paid time off plan
• Health savings account (HSA)
• 401k savings plan
• Access to wages before pay day with myFlexPay
• Flexible spending accounts (FSAs)
• Short- and long-term disability coverage
• Work-Life resources
• Paid parental leave
• Healthy lifestyle programs

Application window anticipated to close: 9/6/26*if interested in opportunity, please submit application as soon as possible.

The salary range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate’s geographical location, relevant education, experience and skills and an evaluation of internal pay equity.

Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply.

Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law.

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