Manager, Provider Credentialing Operations Implementation

Job Summary:

The Manager, Provider Credentialing Operations Implementation is responsible for managing provider credentialing processes for new market implementations within a managed care organization. This position will ensure that all providers meet necessary standards, comply with regulatory requirements, and are efficiently onboarded and maintained within the system.

Essential Functions:

• Manage and lead a team of credentialing specialists to ensure the timely and accurate credentialing of healthcare providers
• Design and implement credentialing policies, workflows, and procedures that ensure compliance with applicable regulatory standards (e.g., NCQA, URAC) and contractual obligations
• Lead projects related to the initial setup and ongoing maintenance of provider credentialing operations and ensure all systems and processes are optimized for efficiency and compliance
• Monitor the credentialing process to ensure all regulatory and internal compliance requirements are met
• Work closely with other departments to ensure smooth implementation and execution of credentialing processes and serve as the key point of contact for provider credentialing inquiries and issues
• Develop and deliver training programs for team members and internal stakeholders on provider credentialing policies, systems, and best practices
• Prepare and present regular reports on credentialing status, performance metrics, and any issues related to provider onboarding and credentialing
• Continuously evaluate the provider credentialing process and recommend improvements to increase operational efficiency, reduce processing time, and enhance provider satisfaction
• Perform any other job duties as requested

Education and Experience:

• Bachelor’s degree in Healthcare Administration, Business Administration, a related field or equivalent years of relevant work experience
• Five (5) years of experience in managing credentialing operations is required
• Previous leadership experience is required
• Experience with credentialing software systems and the use of electronic tools for managing provider data
• Experience with provider data application within Cognizant Facets system

Competencies, Knowledge and Skills:

• In-depth knowledge of provider credentialing regulations, policies, and procedures within managed care organizations
• Skilled in process improvement and project management
• Ability to lead, mentor, and motivate a team to achieve goals and meet deadlines. Strong decision-making and problem-solving capabilities
• In-depth knowledge of credentialing processes, regulations, and industry standards, including NCQA, URAC, CMS guidelines, and state-specific requirements
• High level of accuracy and attention to detail, ensuring all provider information is thoroughly vetted and compliant
• Strong verbal and written communication skills
• Ability to present complex information in a clear and concise manner to both internal stakeholders and external partners
• Proficient in managing multiple projects simultaneously, balancing priorities, and maintaining timelines
• Familiarity with credentialing software systems (e.g., Cactus, CAQH, Verity, or similar platforms), along with MS Office Suite (Excel, Word, PowerPoint)
• Ability to identify issues and implement effective solutions, balancing operational efficiency with regulatory compliance
• Strong focus on customer service, both for internal and external stakeholders
• Ability to analyze and interpret data, track performance metrics, and make data-driven recommendations for improvement

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Occasional travel may be required

Compensation Range:

$81,400.00 - $130,200.00

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others