Credentialing Program Lead

This is a fully remote position, open to applicants in Hawaii.

📋 Description

• Oversee and enhance Modern Health’s credentialing program, which includes initial credentialing, recredentialing, ongoing monitoring, exception management, and documentation standards.

• Direct the administration and operations of the Credentialing Committee, encompassing agenda creation, case preparation, primary source verification review, document management, meeting facilitation, decision tracking, and follow-up actions.

• Ensure that credentialing and recredentialing processes comply with organizational policies, accreditation standards, regulatory requirements, and the enterprise quality governance framework.

• Enhance and scale policies, standard operating procedures (SOPs), controls, and governance processes in line with regulatory and accreditation standards.

• Define and refine program objectives, service level agreements (SLAs), metrics, and reporting to assess timeliness, quality, audit readiness, and operational performance.

• Optimize workflows related to licensure, sanctions, exclusions, malpractice, expirables, renewals, and issue resolution.

• Act as a primary liaison among Provider Operations, Clinical Quality, Compliance, Legal, and Recruiting/Onboarding to bolster provider credentialing oversight, reduce organizational risk, support audit readiness, and enhance accountability to Quality Committee priorities.

• Identify opportunities for process improvement, tooling enhancements, and vendor partnerships that boost scalability, visibility, and provider experience.

• Serve as the credentialing subject matter expert (SME) for audits, escalations, governance reviews, and credentialing-related provider status determinations.

• Support daily credentialing operations while fostering a scalable future-state model.

⛳️ Requirements

• A minimum of 5 years of experience in leading and optimizing credentialing programs, provider operations, provider enrollment, licensing, or similar healthcare operations roles.

• Experience in managing Credentialing Committee activities, provider governance processes, audits, and regulatory assessments.

• Familiarity with credentialing and recredentialing standards, including NCQA, URAC, state regulatory requirements, and delegated credentialing arrangements.

• Proven experience in enhancing credentialing infrastructure, policies, workflows, controls, or operational models in a growing environment.

• Proficient with credentialing software, provider data management systems, primary source verification tools, CAQH, NPDB, provider lifecycle management platforms, and credentialing documentation requirements.

• Experience in supporting audits, accreditation readiness, delegated credentialing oversight, or similar compliance initiatives.

• Strong program management, analytical abilities, and cross-functional communication skills.

• Ability to balance strategic process improvements with hands-on operational execution.

• Candidates must be capable of maintaining work authorization throughout employment without employer sponsorship or employer-provided training plans or attestations (including, for instance, the Form I-983 required for STEM OPT). Immigration sponsorship is not available for this role.

🏝️ Benefits

• Medical / Dental / Vision / Disability / Life Insurance

• High Deductible Health Plan with Health Savings Account (HSA) option

• Flexible Spending Account (FSA)

• Access to coaches and therapists via Modern Health's platform

• Generous Time Off

• Company-wide Collective Pause Days

• Parental Leave Policy

• Family Forming Benefit through Carrot

• Family Assistance Benefit through UrbanSitter

• Professional Development Stipend

• 401k

• Financial Planning Benefit through Origin

• Annual Wellness Stipend to promote overall well-being

• New Hire Stipend to assist with work-from-home setup expenses

• ModSquad Community: Engage in virtual events including active Employee Resource Groups (ERGs), holiday-themed activities, team-building events, and more

• Monthly Cell Phone Reimbursement