Quality Assurance Manager

Job Summary

Overseeing the quality assurance function within the credentialing department, the full-time Manager, Quality Assurance will develop and implement quality assurance strategies, conduct audits, and lead a team to ensure compliance with regulatory standards.

Key responsibilities

• Develop quality assurance plans and audit methodologies for credentialing operations and delegated entities
• Lead and mentor a team of credentialing quality assurance specialists, providing guidance and oversight
• Conduct comprehensive audits to ensure compliance with NCQA, CMS, and other regulatory requirements

Required qualifications

• Bachelor's Degree or equivalent relevant experience
• Five years of experience in healthcare credentialing, including at least two years in a quality assurance role
• Strong knowledge of NCQA, CMS, federal, and state credentialing regulations and standards
• Proven track record of leading and mentoring quality assurance specialists
• Expertise in developing and executing credentialing quality assurance plans and audits