Supervisor, Credentialing job San Francisco California
Supervisor, Credentialing job San Francisco California
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Supervisor, Credentialing Job

Employer Name: SpiderID: 13139904
Location: San Francisco, California Date Posted: 12/23/2022
Wage: Negotiable Category: Insurance
Job Code: 17002AV-2191

Job Description:
Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California's Mission is to ensure all Californians have access to high-quality care at an affordable price. Blue Shield is focused on improving health care delivery by working closely with providers and making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 4 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than $325 million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution.

We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.


Our Company

As a not-for-profit company, our mission says it all: To ensure all Californians have access to high-quality health care at an affordable price.

Driving this mission means being an advocate for care. We have supported universal coverage since 2002 and have taken a market-leading stand on affordability by pledging to limit our net income to 2 percent , meaning we will give back all income over 2 percent to our members and the communities we serve. And since 2005, we have donated more than $200 million dollars to the Blue Shield of California Foundation.

Business Unit: Health Care Quality & Affordability

The Health Care Quality and Affordability team is made up of about 1,000 doctors, nurses, pharmacists, strategists, industry experts and innovators with a single vision - to transform the delivery of health care. Every day, we work together to improve the quality of patient care for our members while lowering health Care costs to ensure all Californians have access to the care they deserve.

How do we do it? Through partnership, innovation, and thought leadership.

We continue to expand our network of providers to ensure state-wide access to care. We evaluate analytic and digital health tools that simplify care delivery while improving member health status, health care quality and affordability as well as member and provider experience. We provide high-touch services to members from experienced clinical teams. You'll also find us collaborating with our federal and state legislative officials to help shape policy to advance our Blue Shield mission.

Position Summary :
The Supervisor, Credentialing is responsible for ongoing credentialing, re-credentialing, and continuous training, monitoring and coaching to facilitate on-going compliance with NCQA Accreditation standards and state and federal requirements. The Supervisor is also responsible for supporting the Senior Manager, Credentialing to ensure compliance with all requirements.

Specific Responsibilities Include:
• Supervises Credentialing staff, including interviewing, hiring, and training employees; planning, assigning, and directing work; performance management and assessment; developing employees, coaching, addressing complaints and resolving problems.
• Administers and oversees the practitioner and provider credentialing process for Blue Shield of California with minimal guidance from manager.
• Reviews and monitors processing of applications, including ensuring timeliness of processing. Evaluates applications and makes recommendations for acceptance or rejection to the Corporate Medical Director based on established guidelines.
• Provides technical support and guidance to team members; educates team members on guidelines and procedures.
• Communicates with external and internal sources to verify or clarify potentially sensitive information pertinent to the application and credentialing process with minimal guidance from manager.
• Develops and maintains processes and procedures for the credentialing verification process and use of the credentialing system; develops and maintains library of related criteria and correspondence.
• Establishes follow-up procedures for periodic updates and review of current network credentialing status.
• Participates in formal and informal reviews and fair hearings; takes and disseminates minutes as appropriate.
• Customizes special education needs from providers as well as delivers strategic communications to assigned providers with minimal guidance.

Implements or supports the credentialing process with support and guidance from manager.


Minimum Education & Experience Requirements :

• Minimum 3 years of experience in health plan credentialing at a supervisor level

• Experience with NCQA accreditation survey process

• Proficiency in computer and software programs (e.g., Microsoft Word, Excel, Access)

Preferences :

• Bachelor's degree preferred

• Knowledge of NCQA accreditation requirements a plus

Our Culture

Blue Shield is dedicated to a healthy and happy workforce. Wellvolution is our award-winning employee wellness program proven to boost employee health, enhance productivity and reduce medical claims costs. We also launched a new culture initiative this year aimed at keeping employees engaged, fulfilled and just happy to work here. This project sets forth a new set of values to guide our culture: trusted and trusting, valuing people, results oriented, agile and nimble, interconnected, creative solutioning and customer centric.

We are proud to work for such a company. I hope you join us.


BSC offers a competitive compensation package comprised of base salary, annual bonus, and full employee benefits (including a defined benefit plan for pension and retiree medical).

Job Criteria:
Start Date:
Position Type: Full-Time Permanent
Years of Experience Required:
Education Required:
Overnight Travel:
Vacation Time:

Contact Information:
Contact Name: Blue Shield of California Company Type:
Company: Blue Shield of California

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