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Macomb County Community Mental Health in Michigan is seeking a Credentialing Specialist who provides specialized support for credentialing, recredentialing, and provider enrollment. You will monitor licensure status, sanctions, and NCQA/NPDB requirements, prepare applications, assist credentialing meetings, and administer MiCal and the Practitioner Directory while protecting confidential information.
The role requires collaboration with leadership across departments to ensure accreditation
Under the direction, provides specialized support for Macomb County Community Mental Health's (MCCMH's) credentialing and Talent Engagement functions. Administers day-to-day credentialing and recredentialing activities for practitioners and other designated MCCMH team members. Supports department operations by serving as a key resource and liaison for credentialing-related matters, supporting accreditation readiness, and other departmental initiatives in accordance with applicable organizational, regulatory, and accreditation requirements.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:
Provides specialized support for credentialing, recredentialing, provider enrollment, and related departmental processes, ensuring compliance with organizational, accreditation, and regulatory requirements.
Conducts ongoing monitoring and primary source verification, including reviews of licensure status, sanctions, exclusions, disciplinary actions, complaints, and other reportable events; researches findings, identifies potential compliance concerns, and escalates issues requiring further review.
Prepares applications, reviews supporting documentation for completeness, and follows up on any missing information.
Participate in credentialing committee meetings and maintain accurate records of attendance, discussions, decisions, and meeting outcomes.
Facilitates credentialing committee activities, including preparing provider summaries, review packets, meeting materials, and compliance reports; compiles and analyzes credentialing data to support credentialing decisions, leadership review, regulatory compliance, and accreditation readiness.
Supports administration of the Organization's National Practitioner Data Bank (NPDB), MiCal, and Practitioner Directory programs, including NPDB queries, sanction screenings, background reviews, and related verification activities.
Provides guidance to team members on credentialing requirements, documentation, enrollment processes, and routine inquiries.
Prepares and assists team members with departmental requests, documentation, training resources, and process guidance to promote consistency and compliance.
Maintains credentialing records, reports, metrics, and tracking tools to support compliance, operational effectiveness, leadership reporting, and continuous improvement.
Assists in maintaining compliance with MCCMH policies, regulatory requirements, National Committee for Quality Assurance (NCQA) standards, and other accrediting agencies.
Updates and administers department content across the Supervisor Resource Hub, SharePoint sites, intranet pages, and other platforms to keep information current.
Assists with Talent Engagement initiatives, workforce compliance activities, special projects, and departmental objectives, as assigned.
Maintains the confidentiality of credentialing, personnel, and organizational information in compliance with applicable laws, regulations, and organizational policies.
Performs other duties as assigned.
QUALIFICATIONS:
Required Education and Experience
Preferred Education and Experience
Required Licenses or Certifications
Preferred Licenses or Certifications
COMPETENCIES FOR SUCCESSFUL PERFORMANCE OF JOB DUTIES
Knowledge of:
Skill in:
Ability to:
GENERAL REQUIREMENTS AND DISCLAIMERS
Complies with P.A. 390, as amended, known as the State’s Emergency Management Act and the County’s Emergency Management resolution as well as all related plans, policies and procedures covered by those statutes. The intent of this job description is to provide a representative summary of the major duties and responsibilities performed by employees in this job. Employees may be requested to perform job-related tasks other than those specifically presented in this description.
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment amongst other possible accommodations.
GRANT OR EXTERNALLY FUNDED POSITION –This position will continue only if sufficient grant or external funds are provided.