Credentialing Manager

Curana Health; United States; Remote; USD 110.000 - 145.000; Vollzeit

Zusammenfassung

Curana Health is seeking an experienced Credentialing Manager to lead our Professional Credentialing team and oversee end-to-end practitioner credentialing and recredentialing.

This role supports regulatory compliance, provider network growth, and efficient credentialing operations across a managed care environment, partnering with data management and IT to optimize workflows and reporting.

The position offers opportunities to drive process improvements and expand into new markets.

Qualifikationen

• Bachelor's degree or equivalent in healthcare or related field.
• Minimum of 7 years in a managed care or large health plan setting.
• 5+ years in provider credentialing and contracting with leadership experience.

Aufgaben

• Lead the end-to-end practitioner credentialing and recredentialing process per CMS/NCQA/state rules.
• Manage a team of credentialing professionals and ensure timely turnaround.
• Monitor provider file inventory, workflows, and quality metrics.
• Develop tracking and reporting to reveal provider status and risks to leadership.
• Oversee credentialing communications, approvals, denials, and information requests.
• Collaborate with data management and IT to improve systems and integrations.

Kenntnisse

CMS/NCQA standards/requirements

Team leadership

Provider data management

Reporting & analytics

Process improvement

Ausbildung

Bachelor's degree or equivalent

Tools

CredentialStream

Excel

SharePoint

Jobbeschreibung

At Curana Health, we're on a mission to radically improve the health, happiness, and dignity of older adults—and we're looking for passionate people to help us do it.

As a national leader in value-based care, we offer senior living communities and skilled nursing facilities a wide range of solutions (including on-site primary care services, Accountable Care Organizations, and Medicare Advantage Special Needs Plans) proven to enhance health outcomes, streamline operations, and create new financial opportunities.

Founded in 2021, we've grown quickly—now serving 200,000+ seniors in 1,500+ communities across 32 states. Our team includes more than 1,000 clinicians alongside care coordinators, analysts, operators, and professionals from all backgrounds, all working together to deliver high-quality, proactive solutions for senior living operators and those they care for.

Ranked #147 on the Inc. 5000 list of America's fastest-growing private companies, we're just getting started. If you're looking to make a meaningful impact on the senior healthcare landscape, you're in the right place—and we look forward to working with you.

For more information about our company, visit CuranaHealth.com.

Summary

We are seeking an experiencedCredentialing Manager to lead our Professional Credentialing team and oversee the end-to-end practitioner credentialing and recredentialing process. This role is critical to maintaining regulatory compliance, supporting provider network growth, and ensuring credentialing operations are completed accurately and efficiently.

The ideal candidate brings substantial experience within a managed care organization or large health plan, along with a strong background in provider credentialing, team leadership, reporting, inventory management, and process improvement. This individual will combine strategic thinking with hands‑on operational leadership to strengthen workflows, improve visibility into credentialing activity, and support expansion into new markets.

Essential Duties & Responsibilities

• Lead and oversee the full practitioner credentialing and recredentialing process in alignment with CMS, NCQA, state, Medicaid, and insurance requirements.
• Manage and support a team of credentialing professionals responsible for professional provider credentialing.
• Monitor provider file inventory, team workflows, production benchmarks, quality assurance, and credentialing turnaround times.
• Establish clear tracking and reporting processes to provide leadership with visibility into provider status, team performance, credentialing volume, and potential risks.
• Develop, implement, and maintain credentialing policies and procedures.
• Identify inefficiencies and lead process‑improvement initiatives that increase consistency, quality, accuracy, and operational efficiency.
• Maintain accurate provider status information within the organization’s provider data management and credentialing systems.
• Oversee credentialing correspondence, including approvals, denials, requests for information, and provider follow‑up.
• Partner with data management and IT teams to support credentialing system integration and operational improvements.
• Research and resolve credentialing issues while implementing solutions that help prevent recurrence.
• Maintain documentation for the Credentialing Committee, manage meeting agendas, and present credentialing recommendations.
• Ensure timely communication with providers and internal stakeholders regarding credentialing status changes.
• Oversee provider outreach, application submission, documentation, and internal quality‑assurance processes.
• Train and support team members, Medical Directors, and health plan partners on credentialing processes and tools.

Qualifications

• Bachelor’s degree or an equivalent combination of education and relevant healthcare experience.
• Minimum of 7 years of experience in a managed care organization or large health plan environment.
• Minimum of 5 years of direct provider credentialing and contracting experience.
• Demonstrated experience leading provider credentialing operations and managing team performance.
• Strong knowledge of physician credentialing standards and requirements established by CMS, NCQA, state agencies, and Medicaid programs.
• Experience using CredentialStream or a comparable credentialing platform.
• Proficiency with Excel and SharePoint.
• Proven experience managing high-volume credentialing workflows, provider file inventory, quality metrics, and operational deadlines.Experience building, improving, or repairing credentialing processes and tracking systems.
• Strong reporting and analytical skills, including the ability to track and interpret credentialing trends and performance.
• Excellent written and verbal communication skills, with the ability to work effectively across organizational levels and with external partners.
• Proficiency with Microsoft Office applications and credentialing management systems.

Preferred Qualifications:

• Experience working for a national or regional managed care organization or large health plan.
• Experience performing SQL-related processes or working with SQL-supported reporting.
• Interest in using AI, automation, bots, or agents to improve operational efficiency.
• Demonstrated success implementing process improvements in a complex, high-volume credentialing environment.

Curana Health is dedicated to the principles of Equal Employment Opportunity. We affirm, in policy and practice, our commitment to diversity. We do not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable or state law, genetic information, or any other characteristic protected by applicable federal, state and local laws and ordinances.

The EEO policy applies to all personnel matters as outlined in our company policy including recruitment, hiring, transfers, and general treatment during employment.

*The company is unable to provide sponsorship for a visa at this time (H1B or otherwise).

We’re thrilled to announce that Curana Health has been named the 147thfastest growing, privately owned company in the nation on Inc. magazine’s prestigious Inc. 5000 list.Curana also ranked 16thin the “Healthcare & Medical” industry category and 21stin Texas.

This recognition underscores Curana Health’s impact in transforming senior housing by supporting operator stability and ensuring seniors receive the high-quality care they deserve.