Manager of Credentialing Operations

Job Summary

Managing the operations of credentialing and provider data management functions, the full-time Manager of Credentialing Operations will ensure compliance with regulatory standards while overseeing the credentialing of healthcare providers and collaborating on network expansion initiatives in a remote environment.

Key responsibilities

• Oversee the credentialing and re-credentialing of physicians and organizational providers across multiple business units
• Ensure compliance with NCQA and DHHS credentialing requirements while participating in NCQA accreditation activities
• Identify and implement process improvements to enhance efficiency and reduce costs within the department

Required qualifications

• Bachelor's degree in a related field or equivalent experience
• 5+ years of management and provider data management or credentialing experience, preferably in a managed care or insurance environment
• Previous supervisory experience, including hiring, training, and managing staff performance
• Experience managing cross-functional teams on large-scale projects
• Knowledge of NCQA, CMS, and other regulatory agency requirements