Highmark Health
Harrisburg, PA, USA
Company : Highmark Inc. Job Description : JOB SUMMARY This job coordinates and maintains delegated credentialing program in accordance with GHP, NCQA, and all regulatory agency standards. This includes delegation program, policies/procedures, and all necessary compliance documentation. The incumbent coordinates, conducts, and evaluates all pre-delegation assessments, annual oversight audits, and the ongoing monitoring of recommendations and work plans. Coordinates and maintains all delegation agreements. ESSENTIAL RESPONSIBILITIES Implement GHP Programs. Facilitate problem resolution when needed. Provide daily oversight of credentialing delegates to ensure that the delegated entities meet all NCQA, DPW, and DOH, policies and procedures related to GHP's delegated program. Establish and implement monitoring processes to evaluate performance against contract standards, requirements and performance expectations. Identify opportunities...

