Maryland Licensed Credentialing Director

Job Summary

Reporting to the Executive Director of Health Services, the full-time Maryland Licensed Credentialing Director will manage all credentialing activities for Medicaid, Medicare, Commercial, and Tricare lines of business, ensuring compliance with NCQA guidelines and industry standards while primarily working remotely with occasional in-office requirements.

Key responsibilities

• Ensures compliance with relevant regulations and industry standards for credentialing and re-credentialing
• Oversees relationships with credentialing vendors and ensures timely completion of primary source verification activities
• Collaborates with various departments to enhance onboarding processes and implement quality assurance programs

Required qualifications

• Bachelor's Degree in Business Administration/Management or related field
• Minimum of 7 years of experience in a managed care health plan environment with credentialing experience
• 3 years of experience in a management capacity role
• Master's Degree (preferred)
• CPCS - Cert Provider Credentialing Specialist (preferred)