Senior Manager, Licensing and Credentialing

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

📋 Description

• Design and implement a proactive licensing and credentialing program that matches clinician volume, target states, payer panels, growth objectives, and launch schedules.

• Oversee and manage the delegated credentialing process in accordance with NCQA standards and payer specifications.

• Supervise licensing and credentialing vendors, ensuring performance, accountability, and contract compliance.

• Act as the operational link between vendors and clinicians, addressing bottlenecks and guaranteeing a seamless clinician experience.

• Collaborate with Compliance on payer audits, OIG and SAM exclusion reporting for external vendors, and regulatory submissions.

• Lead the NCQA certification initiative to internalize licensing and credentialing processes.

• Monitor and manage state license renewals, DEA registrations, and payer re-credentialing activities.

• Direct the creation, attestation, and upkeep of clinician CAQH profiles.

• Ensure precise provider roster submissions to health plans.

• Manage the credentialing vendor platform, ensuring data integrity, secure document retention, and workflow automation.

• Innovate workflows utilizing AI, automation, and cutting-edge technologies.

• Establish and communicate KPIs to executive leadership, such as turnaround times, defect rates, and vendor SLA compliance.

• Collaborate with leadership, clinical teams, and vendors to develop a scalable and dependable function.

• Utilize virtual tools to manage tasks and communications in a remote working environment.

⛳️ Requirements

• Direct experience in managing delegated credentialing programs, encompassing NCQA standards, payer delegated agreements, and multi-state licensing criteria.

• Demonstrated success in leveraging AI, automation, or continuous improvement strategies.

• Experience in overseeing credentialing and licensing vendors.

• Proven background in hiring, leading, and managing team performance.

• Experience in scaling licensing and credentialing functions in a startup or rapidly growing healthcare or telehealth setting.

• Operational understanding of clinical, care management, and data exchange processes typical in value-based care or telehealth organizations.

• Exceptional communication and influencing abilities.

• Strong project management capabilities with the ability to handle multiple workstreams simultaneously.

• 5–7 years of experience in licensing and credentialing.

• At least 3 years of direct experience in managing credentialing and/or licensing functions, including delegated credentialing programs.

• Familiarity with Medicare, Medicare Advantage, and Medicaid programs.

• Experience in a telehealth or multi-state provider context is highly preferred.

• Proficient in credentialing and provider data management software.

• A bachelor's degree in a relevant field or equivalent experience is required.

• An advanced degree or professional certifications, such as CPCS or CPMSM from NAMSS, are strongly preferred.

• Ability to remain seated for extended periods while working at a computer.

• Capability to lift up to ten pounds.

🏝️ Benefits

• Fully remote work-from-home position.

• Company-provided equipment.

• Minimal travel requirements.

• Inclusive and accessible applicant experience.

• Workplace accommodations available throughout the hiring process.