Senior Manager, Licensing and Credentialing
Core
Building strategy and execution for credentialing and licensing operations to ensure provider compliance with federal, state, and regulatory standards.
Role type
Senior Manager, Licensing and Credentialing
Builds
End-to-end credentialing and multi-state licensing processes and systems
Domain
Healthcare / Provider Platforms
Deliverable
dashboards & analysis
Required skills
Credentialing process design, Multi-state licensing management, Team supervision, Regulatory compliance, Medicare/Medicaid enrollment, Workflow optimization, Data reporting
Preferred skills
Healthcare industry experience, Provider platform knowledge (CAQH, PECOS)
Responsibilities
Own end-to-end credentialing and multi-state licensing process; Oversee provider onboarding/offboarding and ongoing credentialing; Operate delegated credentialing program and manage health plan audits; Manage entity-level enrollment in Medicare and Medicaid; Ensure compliance with state and federal regulations; Establish and monitor state-specific supervision ratios and prescriptive authority rules; Build efficient internal workflows; Establish and maintain dashboards and reporting systems; Manage team development and performance.
Seniority
Senior, hands-on IC with supervisory responsibilities