Director of Credentialing

Jobtailor; New York (NY); On-site; USD 110,000 - 180,000; Full time

Job summary

Jobtailor in New York is seeking an experienced leader to oversee direct and delegated credentialing, ensuring accreditation and regulatory compliance. You will lead credentialing operations, manage data governance, KPIs, and vendor relationships, and partner with providers, HR, compliance, and legal.

A CPCS or CPMSM certification and 10+ years in medical staff services are preferred. This role emphasizes process improvement, audits, committee governance, and timely credentialing decisions.

Qualifications

• Proven leadership in credentialing ops and teams.
• Experience adhering to Joint Commission, NCQA, CMS Conditions of Participation and state/federal requirements.
• Experience with delegated credentialing oversight and audit readiness.
• Experience with corrective action planning.
• Proficiency with credentialing software/CVO platforms, databases, and reporting tools.
• Strong data quality discipline.
• Ability to develop and manage policies, workflows, and metrics.
• Ability to lead process improvement and change management.
• Strong judgment and discretion.
• Ability to maintain confidentiality with sensitive peer review and credentialing information.
• Availability to support committee meetings and deadlines.
• 10+ years in medical staff services/credentialing.
• Bachelor’s degree preferred (or equivalent experience).
• CPCS or CPMSM required.

Responsibilities

• Provide oversight of direct and delegated credentialing processes
• Ensure accreditation and regulatory compliance
• Lead credentialing operations, including workflow improvement and staff supervision
• Support compliance through audits, document reviews, and site reviews
• Define and monitor credentialing KPIs and SLAs
• Drive continuous improvement
• Serve as escalation point for providers, HR, and compliance
• Own committee governance and action follow-through
• Identify credentialing risks and implement mitigation plans
• Manage vendors and CVOs, including contracts and performance
• Establish data governance and deliver routine leadership reports
• Coordinate provider lifecycle workflows
• Train stakeholders and standardize criteria and workflows across entities

Skills

People leadership

Regulatory knowledge

Delegated credentialing oversight

Audit readiness

Credentialing software

Data quality discipline

Policy development

Process improvement

Confidentiality

Committee coordination

Vendor management

Risk identification

Education

Bachelor’s degree or equivalent experience

CPCS

CPMSM

Tools

CVO Platforms

Reporting Tools

Job description

• Provide oversight of direct and delegated credentialing processes
• Ensure accreditation and regulatory compliance
• Lead credentialing operations, including database maintenance, workflow improvement, file and report management, records and communication policies, and staff hiring and supervision
• Support compliance through document review, delegated-entity audits, sanctions/complaints review, and site reviews
• Define and monitor credentialing KPIs and SLAs, including turnaround time, quality audits, and file completeness
• Drive continuous improvement
• Serve as escalation point and partner for providers, staff leadership, HR/recruiting, and compliance/legal
• Own committee governance, including agendas, minutes, decision tracking, and action follow-through
• Identify credentialing risks and trends and implement mitigation plans
• Manage vendors and CVOs, including contracts, performance, and issue resolution
• Establish data governance and deliver routine reporting to leadership
• Coordinate provider lifecycle workflows
• Train stakeholders and standardize criteria and workflows across entities

Requirements

• Proven people leadership, including hiring, coaching, and performance management
• Working knowledge of The Joint Commission, NCQA, CMS Conditions of Participation, and applicable state/federal requirements
• Experience with delegated credentialing oversight and audit readiness
• Experience with corrective action planning
• Proficiency with credentialing software/CVO platforms, databases, and reporting tools
• Strong data quality discipline
• Ability to develop and manage policies, workflows, and metrics
• Ability to lead process improvement and change management
• Strong judgment and discretion
• Ability to maintain confidentiality with sensitive peer review and credentialing information
• Availability to support committee meetings and deadlines
• 10+ years in medical staff services/credentialing
• Bachelor’s degree preferred (or equivalent experience)
• CPCS or CPMSM required
• Must be based in the United States
• Must be authorized to work in the United States without sponsorship, now or in the future

Core Competencies

Demonstrates expertise in credentialing operations, including oversight of processes, compliance with regulatory standards, and management of performance metrics. Proven ability to lead teams, implement process improvements, and maintain data governance in a healthcare environment.

Highest-signal resume keywords

• Credentialing Oversight
• Regulatory Compliance
• Data Governance
• People Leadership
• CPCS or CPMSM Certification

Hard Skills

• Credentialing Software
• Database Management
• Workflow Improvement
• Performance Management
• Corrective Action Planning
• KPI Monitoring
• Audit Readiness
• Document Review
• Risk Identification
• Policy Development

Soft Skills

• Strong Judgment
• Discretion
• Coaching
• Confidentiality
• Collaboration

Certifications & Qualifications

• CPCS
• CPMSM

Industry Keywords

• The Joint Commission
• NCQA
• CMS Conditions of Participation
• Medical Staff Services
• Credentialing KPIs
• Credentialing Risks
• Delegated Credentialing

Tools & Technologies

• CVO Platforms
• Reporting Tools