Job Description

We are looking for a Credentialing Specialist to join us in leading our organization forward.

McLaren Integrated HMO Group (MIG), a division of McLaren Health Care Corporation, is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives.

McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plans can thrive. As an employee MIG, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.

McLaren Health Plan is our Michigan-based health plan dedicated to meeting the health care needs of each of our Michigan members. Learn more about McLaren Health Plan at

MDwise is our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs. Learn more about MDwise, Inc. at

Position Summary:

Responsible for processing and maintaining all potential provider applications for participation with The Plan. Generates provider profiles in the credentialing data base, including creation of the Council for Affordable Quality Healthcare (CAQH) records and liaison with PVCS. Responsible for meeting established provider credentialing timelines. Develops and implement processes to monitor credentialing National Committee for Quality Assurance (NCQA) standards and all other regulatory agencies and ensure The Plan\xe2\x80\x99s compliance with such. Supports and coordinates credentialing activities with Network Development. Assists in preparing credentialing activity reports and other ad hoc reports as necessary. Responsible for research and resolution of identification and resolution of credentialing issues. Identifies process improvement opportunities and develops plans to address opportunities.

Credentialing experience perferred.

This position is fully remote.

Equal Opportunity Employer of Minorities/Females/Disabled/Veterans

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Qualifications:

Required:

• High School Diploma or equivalent (GED)
• One (1) year experience in a HMO, provider office, or health care.

Preferred:

• Associate degree in business, health care or related field.
• Two (2) years\xe2\x80\x99 experience in a HMO, provider office, or health care.
• Two (2) years healthcare claims and/or billing experience with basic understanding of payment methodology and medical terminology.

Additional Information

• Schedule: Full-time
• Requisition ID: 24000963
• Daily Work Times: 8:30 am - 5:00 pm
• Hours Per Pay Period: 80
• On Call: No
• Weekends: No

Equal Opportunity Employer

McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status, national origin, disability, genetic information, height or weight, protected veteran or other classification protected by law.

McLaren Health Care