Senior Manager Credentialing

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

The Sr Manager, Credentialing Compliance & Collaboration Programs will play a critical role in ensuring ongoing alignment with NCQA credentialing standards while also overseeing a team responsible for the assignment and management of collaborating physicians and delegation agreements.

In this role you will be dedicated to developing, managing, and monitoring NCQA-compliant processes, documentation, and readiness.  You will also focus on leading the Collaboration Team, ensuring timely and compliant execution of physician assignments and agreement management across all participating states.

Work Environment & Logistics

• Standard business hours with occasional need for extended hours during audits or major initiatives.

• Will consider hybrid and remote work arrangement as business needs allow.

Key Responsibilities:
 

NCQA Credentialing Compliance 

• Serve as the department’s subject matter expert on NCQA credentialing standards.

• Monitor and maintain compliance with NCQA credentialing and recredentialing requirements.

• Lead the development, updates, and implementation of NCQA-required policies, procedures, and quality improvement plans.

• Coordinate NCQA readiness activities including audits, file reviews, and delegation oversight.

• Conduct frequent NCQA mock reviews annually 

• Partner with quality, compliance, and audit teams to conduct internal reviews and implement corrective actions as needed.

• Educate and train internal stakeholders on NCQA standards and expectations.

• Ensure timely tracking and documentation of performance metrics required by NCQA.

Collaboration Team Oversight 

• Lead and support the Collaboration Team responsible for assigning collaborating physicians to nurse practitioners and physician assistants.

• Ensure timely and compliant execution of collaboration and delegation agreements.

• Manage physician roster capacity and track assignment trends to optimize alignment and efficiency.

• Support communication and issue resolution between clinical partners and internal stakeholders.

• Ensure agreements meet legal and regulatory requirements for each state.

• Collaborate with Compliance and Legal to refine agreement templates and manage contract updates.

• Monitor and report on collaboration metrics and team productivity.

Basic Qualifications:

• Bachelor’s degree required; Master’s degree in healthcare administration, public health, or related field preferred.

• 5+ years of experience in healthcare credentialing, compliance, or NCQA-regulated environments.

• 2+ years in a leadership or people management role.

• Deep knowledge of NCQA credentialing standards and accreditation readiness processes.

• Experience with contract development and understanding of state-specific delegation requirements.

• Proven ability to lead cross-functional initiatives and drive performance through others.

• Excellent organizational, communication, and project management skills.

• High proficiency in Microsoft Office and credentialing software systems.

Preferred Qualifications:

• NCQA Surveyor or Certified Professional in Credentialing or Healthcare Quality (CPCS, CPMSM, CPHQ) a plus.

• Experience with multi-state provider networks and physician collaboration requirements.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$60,300.