Credentialing Supervisor

Minneapolis, Minnesota
Mar 24, 2018
Apr 21, 2018
Employment Status
Full Time

Health Care that Starts with You!

Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.


At UCare, we deliver high-quality health coverage and services to help members of all ages maintain and improve their health. It's a big job that takes innovative ideas, strategic partnerships, and a commitment to doing the right thing. Above all, it takes a compassionate team that is dedicated to making a real difference in the lives of our members and our communities.



Working at UCare is more than just a career; it's a mission. A mission that defines us as professionals, unites us as an organization, and shapes how we interact with our members and each other. Our values of integrity, community, quality, flexibility, and respect permeate every aspect of our organization - from who we are and how we act, to what we do and how we do it. We owe our continued success to our employees who proudly embody our mission and values in everything they do.




Position Description

This position is responsible for recruiting, training and direct supervision of the Credentialing team which includes managing data in the credentialing database,  processing practitioner/provider credentialing and delegation oversight.  Create optimal performance, quality assurance, and efficiencies within the team responsibilities.  This position is responsible for assuring the credentialing and delegation process and demographic data management meet all regulatory and  accreditation requirements based on legislative mandates and company strategic direction.   Specific duties and responsibilities include:


Supervise a comprehensive credentialing and recredentialing program for physicians, allied health professionals, and facilities which meets regulatory and accreditation guidelines.  Coordinate the program with other departments within the organization, especially the Medical Directors, Legal, Provider Enrollment and Configuration and Provider Relations and Contracting.

Represent UCare for regulatory audits related to Credentialing, including CMS, DHS, MDH, NCQA and other auditing agencies.

Interpret and apply NCQA Standards and State/Federal regulations related to credentialing, department procedures, references and implementation/training. 

Advise UCare on regulatory requirements related to credentialing issues.  Recommends and drafts written policies to ensure UCare meets these requirements.

Manage staff to ensure timely execution of credentialing, provider set up and accurate data entry into Cactus.  Train, monitor and coach members of the team including maintaining the daily schedules, productivity and workflow.  Provide feedback on performance in a timely manner. 

Attend credentialing related meetings.  Assist the Assistant Director in preparing credentialing file reports, Credentialing Committee materials, work with Medical Directors as needed, and present credentialing files and peer review to appropriate committees for approval. 

Manage and analyze key performance metrics, and direct process improvement activities as necessary to ensure acceptable performance levels for accuracy and timeliness. 

Supervise and conduct the delegation annual audits and processes of the credentialing delegates and external vendors.  

Collaborate with internal customers on maximizing the opportunities in Cactus for the use of provider directories and Find-A-Doc.  

Represent UCare on community collaborative initiatives related to Credentialing. 

Other projects and duties as assigned.


Bachelor's degree in medical records or other health related field; demonstrated experience may be considered in lieu of a degree.  Certification in credentialing from the National Association of Medical Staff Services desired.

Required Experience

Three years relevant experience in a health care delivery system.  Four years experience in Credentialing.  One year of experience related to Health Plan operations.

Preferred Experience

Credentialing and supervisory experience desired.  Centers for Medicare and Medicaid Services (CMS) and Department of Human Services (DHS) guidelines, rules, and regulations, NCQA knowledge required.


UCare is proud to be a recognized Star Tribune Top Workplace for the 7th consecutive year. As a part of our collaborative team, you'll experience the rewards that come with helping others and seeing the positive results of your hard work. We value and respect each individual's ideas and contributions, and give you the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, a myriad of volunteer activities, and a number of other rewards. If you're looking for a welcoming environment that celebrates what you have to offer, helps you build on your strengths, and gives you the opportunity to truly make a difference, we invite you to apply.


As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.


Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers. At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.

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