Credentialing Program Lead: Quality & Compliance

Western Health Advantage; Sacramento (CA); Hybrid; USD 70,000 - 85,000; Full time

Job summary

Western Health Advantage is seeking an experienced Credentialing Specialist to support our Quality Management team in achieving the organization’s Quality Improvement and Credentialing Program goals. This position leads credentialing oversight activities and helps ensure compliance with NCQA accreditation standards and DMHC regulatory requirements.

The Credentialing Specialist works closely with internal leadership, Medical Management staff, delegated medical groups, and IPAs to promote

Qualifications

• Bachelor’s degree in a healthcare-related field is preferred.
• 4+ years of NCQA credentialing experience.
• CPCS certification preferred; must be obtained within 2–3 years.
• Experience in healthcare/HMO environment is a plus.
• Strong knowledge of credentialing standards, audits, and regulatory requirements.
• Excellent organizational, analytical, and communication skills.

Responsibilities

• Lead credentialing program and ensure compliance with accreditation standards.
• Oversee credentialing policies, procedures, and delegated credentialing.
• Perform annual credentialing file reviews and audits; manage corrective actions.
• Educate delegated entities on credentialing requirements and report findings.
• Coordinate credentialing committee meetings and reporting.
• Support NCQA accreditation and DMHC survey readiness and post-survey follow-up.
• Manage multiple projects and timelines to meet deadlines.

Skills

NCQA credentialing oversight

Organizational skills

Analytical skills

Communication and presentation skills

Education

Bachelor’s degree in a healthcare-related field

CPCS certification (preferred; within 2–3 years)

Tools

Microsoft Office

Job description

Western Health Advantage is seeking an experienced Credentialing Specialist to support our Quality Management team in achieving the organization’s Quality Improvement and Credentialing Program goals. This position leads credentialing oversight activities and helps ensure compliance with NCQA accreditation standards and DMHC regulatory requirements.

The Credentialing Specialist works closely with internal leadership, Medical Management staff, delegated medical groups, and IPAs to promote