Jasmine Kay Email & Phone Number

• Oversee credentialing for initial appointments and recredentialing of medical staff, allied health professionals, network providers and healthcare delivery organizations.• Verify provider credentials, including education, training, licensure and work history, using the CAQH database and other sources to ensure compliance with standards. • Confirm healthcare delivery organizations' Medicare status, licensures and certifications to ensure regulatory compliance for network participation.• Maintain provider directories and databases, updating provider information, credentialing status, and network participation details in accordance with regulatory requirements and health plan policies.• Monitor and track expirables, such as licenses, certifications and malpractice insurance, proactively identifying and addressing potential compliance issues.• Collaborate with internal teams, external credentialing agencies, and healthcare providers to resolve any discrepancies or issues identified during the verification process, ensuring timely resolution and completion of credentialing activities.

Sacramento, California, United States

• Review prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Medical Director with recommendations for other determinations.• Enter and maintain pertinent clinical information in various medical management systems• Prepares communications, including denial, approved with modifications and deferral letters using standard templates