Director, Credentialing & Peer Review Operations

Alameda Alliance for Health; Alameda (CA); Hybrid; USD 181,000 - 272,000; Full time

Job summary

Alameda Alliance for Health is seeking a Sr. Manager, Peer Review and Credentialing to lead credentialing for physicians, allied health practitioners, and organizational providers. The role includes supervising credentialing staff and vendors to ensure NCQA, CMS, DHCS, DMHC compliance.

This hybrid role requires coordinating audits, improving processes, and reporting to the CMO and Compliance. Responsible for maintaining confidentiality and adherence to regulatory standards.

Qualifications

• BA/BS degree required or equivalent credentialing work experience.
• NAMSS CPCS and/or CPMSM certification required.
• Minimum five years of credentialing experience in a health care/managed care environment.
• Minimum three to five years supervisory experience.
• Knowledge of CMS, DHCS, DMHC, NCQA standards.
• Excellent interpersonal and persuasive communication skills.
• Proficient with Microsoft Office including Access.
• Ability to work independently.

Responsibilities

• Oversee credentialing and peer review staff to ensure regulatory compliance.
• Liaise with credentialing vendors and audits; review invoices.
• Manage annual credentialing audits and corrective action plans.
• Coordinate credentialing with Compliance and Network Management.
• Prepare reports for CMO and Compliance.
• Serve as primary internal credentialing audits resource.
• Maintain confidentiality of credentialing records.
• Develop and update credentialing policies and workflows.

Skills

Interpersonal skills

Persuasive communication

Independent work

CMS/NCQA knowledge

MS Office (Access)

Education

BA/BS degree

NAMSS CPCS/CPMSM

Tools

CAQH services

Cactus

Credentialing database

Job description

Alameda Alliance for Health is seeking a Sr. Manager, Peer Review and Credentialing to lead credentialing for physicians, allied health practitioners, and organizational providers. The role includes supervising credentialing staff and vendors to ensure NCQA, CMS, DHCS, DMHC compliance.

This hybrid role requires coordinating audits, improving processes, and reporting to the CMO and Compliance. Responsible for maintaining confidentiality and adherence to regulatory standards.