Senior Manager of Strategic Credentialing and Network Operations
Core
Own the end-to-end credentialing engine to get clinicians active and paneled across multi-state markets, driving down provider ramp time and managing delegated credentialing arrangements.
Role type
Senior Manager of Strategic Credentialing and Network Operations
Builds
Provider enrollment pipelines for commercial and Medicaid/MCO health plans
Domain
Healthcare (Pediatric Mental Health) + Multi-state Regulatory Compliance
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Multi-state provider enrollment, Delegated credentialing management, NCQA standards expertise, Medicaid/MCO regulatory compliance, Vendor SLA management, Audit readiness
Preferred skills
CPCS or CPCS-MS certification, Behavioral health credentialing experience
Technologies
EHR data integrations, Credentialing management systems
Responsibilities
Drive provider ramp time from offer acceptance to billing activation, Direct third-party credentialing vendors and establish KPIs/SLAs, Build and maintain delegated credentialing arrangements, Partner with RCM, Clinical Ops, Legal, and Tech to optimize roster management
Seniority
Senior, hands-on IC