Credentialing Manager

University of California - Los Angeles Health; Los Angeles (CA); On-site; USD 81,000 - 169,000; Full time

Job summary

The University of California - Los Angeles Health is seeking a Credentialing Manager to lead provider credentialing and recredentialing operations while ensuring compliance with regulatory, accreditation, contractual, and organizational requirements. This role drives development and continuous improvement of credentialing programs across all lines of business.

Responsibilities include leading the credentialing team, overseeing audits, implementing policies and workflows, coordinating with health

Qualifications

• Bachelor's degree in healthcare administration or related field; candidates without a degree need four additional years of relevant credentialing experience on top of five years of credentialing experience.
• Five+ years of credentialing experience in a complex health plan, IPA, or managed care organization.
• Three+ years of people management, including at least two years supervising Provider Relations and/or Member Services.
• In-depth knowledge of CMS, NCQA, DMHC, DHCS, and HICE regulatory standards.

Responsibilities

• Lead, develop, and manage the Credentialing team, including hiring, training, performance management, and goal setting.
• Oversee end-to-end credentialing and recredentialing operations, including application review and primary source verification.
• Ensure compliance with NCQA, regulatory, contractual, and organizational standards, including turnaround times and reporting requirements.
• Maintain audit readiness and manage credentialing audits and corrective action plans.
• Develop, implement, and maintain credentialing policies, procedures, workflows, and delegation agreements.
• Lead Credentialing Committee activities, including file review, meeting facilitation, documentation, and follow-up actions.
• Serve as a subject matter expert and liaison for health plans, regulatory agencies, accreditation bodies, and internal stakeholders.
• Oversee credentialing systems, vendor performance, and provider data integrity; identify and implement system and process improvements.
• Monitor and report on operational metrics, productivity, and quality standards to identify trends and improvement opportunities.
• Lead process improvement and operational efficiency initiatives, including project planning and implementation.
• Support budget oversight and ensure effective use of resources.

Skills

Credentialing

Team leadership

Regulatory compliance

NCQA knowledge

Provider relations

Audits & actions

MS Excel / Word

MD Staff familiarity

Education

Bachelor's degree in healthcare administration or related field

Tools

MD Staff

EPIC Tapestry

Job description

Description

The Credentialing Manager provides leadership and oversight for provider credentialing and recredentialing operations, ensuring processes and programs remain compliant with applicable regulatory, accreditation, contractual, and organizational requirements. This role is responsible for the ongoing development, implementation, monitoring, and continuous improvement of credentialing programs across all lines of business.

Key Responsibilities

• Lead, develop, and manage the Credentialing team, including hiring, training, performance management, and goal setting.
• Oversee end-to-end credentialing and recredentialing operations, including application review, primary source verification, and ongoing monitoring.
• Ensure compliance with NCQA, regulatory, contractual, and organizational standards, including turnaround times and reporting requirements.
• Maintain audit readiness and manage credentialing audits, corrective action plans, and remediation efforts.
• Develop, implement, and maintain credentialing policies, procedures, workflows, and delegation agreements.
• Lead Credentialing Committee activities, including file review, meeting facilitation, documentation, and follow-up actions.
• Serve as a subject matter expert and liaison for health plans, regulatory agencies, accreditation bodies, and internal stakeholders.
• Oversee credentialing systems, vendor performance, and provider data integrity; identify and implement system and process improvements.
• Monitor and report on operational metrics, productivity, and quality standards to identify trends and improvement opportunities.
• Lead process improvement and operational efficiency initiatives, including project planning and implementation.
• Support budget oversight and ensure effective use of resources.

Salary Range: $80,700 - $168,500/annually

Qualifications

• Bachelor's degree in healthcare administration or other related field or a combination of equivalent education, training & experience. Candidates without a degree must have four (4) years of relevant professional experience in addition to the required five (5) years of credentialing experience. - REQUIRED
• Five years or more of previous experience in Credentialing working for a complex and diversified health plan, IPA, or other managed care organization - REQUIRED
• Three years or more experience managing personnel with at least two years supervising personnel in Provider Relations and/or Member Services - REQUIRED
• In depth knowledge of healthcare industry regulatory agencies, credentialing and provider directory standards including but not limited to CMS, NCQA, DMHC, DHCS, and HICE.
• Extensive understanding and experience using credentialing systems including the flow of credentialing and provider demographic information.
• Demonstrated computer skills; proficient with Microsoft Windows applications including but not limited to Excel, Word, Teams and Outlook.
• Demonstrated software skills in MD Staff - PREFERRED
• Familiarity with EPIC Tapestry
• Ability to travel/attend off-site meetings and conferences, when necessary
• CPMSM or CPCS - PREFERRED