Director, Credentialing & Accreditation

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

📋 Description

• Provide leadership in operations and regulatory compliance for enterprise credentialing, recredentialing, clinical privileging, accreditation, and medical staff compliance activities.

• Convert directives from senior leadership into actionable operational plans, performance expectations, policies, and controls.

• Supervise credentialing, privileging, certification/accreditation, and other operational managers.

• Act as the main escalation contact for complex files, compliance issues, and cross-functional challenges.

• Collaborate with medical staff leaders, hospital administration, quality assurance, compliance, legal, IT, payer enrollment, and affiliated organizations.

• Lead processes for primary source verification, ongoing monitoring, application and file review, and timely approval workflows.

• Assist in operational planning, resource allocation, vendor and contract management, budget oversight, risk management, and communications.

• Mentor, coach, and assess managers, supervisors, and assigned staff.

• Direct compliance and readiness initiatives for TJC, CMS, NCQA, New York State DOH, OSHA, NPDB, delegated payers, and other standards.

• Oversee accreditation surveys, regulatory reviews, delegated credentialing audits, internal assessments, corrective action plans, and remediation efforts.

• Create, review, route, implement, and sustain policies and procedures related to credentialing, privileging, reappointment, monitoring, and accreditation.

• Manage specialty-specific, criteria-based privilege forms and OPPE/FPPE processes.

• Prepare and evaluate files, agendas, recommendations, and documentation for credentials committees, medical executive committees, and governing boards.

• Provide guidance on complex or adverse credentialing matters and monitor licenses, DEA registrations, board certifications, health requirements, sanctions, exclusions, and NPDB reports.

• Serve as a subject matter expert and escalation resource in credentialing, privileging, accreditation, and medical staff compliance.

• Maintain professional expertise through associations, education, conferences, and updates on regulatory changes.

⛳️ Requirements

• A Bachelor's degree in business, healthcare administration, health information management, or a related field, along with 6 years of progressively responsible experience in medical staff services, credentialing, privileging, and accreditation is required.

• An equivalent combination of education and experience will be considered.

• Proven experience in supporting regulatory surveys, accreditation reviews, delegated credentialing audits, policy development, corrective action plans, and ongoing compliance monitoring is essential.

• Advanced understanding of medical staff credentialing and privileging principles, as well as applicable TJC, CMS, NCQA, DOH, OSHA, NPDB, and delegated credentialing standards is required.

• A demonstrated ability to set performance measures, analyze operational data, enhance workflows, manage change, and guide teams through organizational or technological transformations is necessary.

• Exceptional written, verbal, interpersonal, and presentation skills are required.

• A Master's degree is preferred.

• Experience with OPPE/FPPE, criteria-based privilege development, medical staff committee processes, and governing board functions, as well as complex credentialing issue resolution is preferred.

• CPMSM certification is preferred.

• CPCS certification is preferred.

• Achievement of a relevant NAMSS certification within an organization-established timeframe is preferred.

🏝️ Benefits

• Comprehensive health, dental, and vision insurance.

• Retirement savings plan with employer matching.

• Generous paid time off and holiday schedule.

• Continuing education and professional development opportunities.

• Flexible work schedule options.