Senior Manager, Strategic Credentialing and Network Operations

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

📋 Description

• Oversee provider enrollment across multiple states for commercial and Medicaid/MCO plans, streamlining the process from offer acceptance to billing activation.

• Manage third-party credentialing vendors, setting KPIs, SLAs, and accountability frameworks to eliminate onboarding delays.

• Develop, sustain, and implement health plan delegated credentialing agreements.

• Lead preparations for NCQA/MCO audits.

• Collaborate with RCM, Clinical Operations, Legal, and Technology teams to enhance provider roster management, EHR data integrations, and billing alignment.

• Report directly to the Senior Vice President of Finance.

• Act as the credentialing engine owner across Finance, Clinical Operations, RCM, and Technology departments.

⛳️ Requirements

• A minimum of 8 years of experience in healthcare credentialing and provider enrollment (experience in multi-state behavioral/mental health is preferred).

• Demonstrated success in managing delegated credentialing processes and health plan audit standards.

• Practical experience in overseeing third-party vendors in accordance with SLAs.

• Strong understanding of NCQA standards and Medicaid/MCO regulations.

• Extensive knowledge of health plan delegation audits and MCO/Medicaid compliance requirements.

• Experience in identifying operational bottlenecks, monitoring provider-to-payer ramp metrics, and automating workflows.

• Proven ability to foster collaborative relationships with health plan network directors, internal executive stakeholders, and external vendors.

• Certification as a Provider Credentialing Specialist (CPCS) or CPCS-MS is preferred.

🏝️ Benefits

• Comprehensive Medical, Dental & Vision insurance.

• 401(k) plan with company match.

• Employer-funded life insurance.

• Generous paid time off policy.

• A diverse and experienced leadership team with a supportive culture.