Provider Network Strategy Manager

Season Health; New York (NY); Hybrid; USD 110,000 - 130,000; Full time

Job summary

An innovative firm is seeking a Provider Network Strategy Manager to lead credentialing for their telehealth platform. This role involves strategic development and operational management of the credentialing function, ensuring compliance with regulatory standards while collaborating with various internal departments. The ideal candidate will have extensive experience in healthcare credentialing, particularly in telehealth environments, and will play a pivotal role in expanding the organization's network relationships. Join a mission-driven company that values flexibility and offers significant benefits, including competitive wages and unlimited PTO.

Benefits

Medical, Dental, and Vision Benefits

401k Plan

Unlimited PTO

Training and Mentorship Opportunities

Equity Compensation

Qualifications

• 5+ years in healthcare credentialing, with management experience.
• Deep knowledge of CAQH, NCQA, and health plan requirements.

Responsibilities

• Lead credentialing strategy and operations for telehealth.
• Manage credentialing staff and oversee compliance with regulations.

Skills

Healthcare Credentialing

Telehealth Operations

Analytical Skills

Interpersonal Communication

Problem-Solving

Education

Bachelor's Degree

MBA or Master's in Healthcare Administration

Tools

Credentialing Software Platforms

Database Management

Job description

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About Season

At Season Health, we’re revolutionizing healthcare through our innovative telehealth platform. We connect patients with expert clinicians, including one of the largest networks of registered dietitians nationwide, to help them achieve meaningful health outcomes. Our integrated approach combines personalized clinical care with a curated marketplace featuring national and local vendors, all enhanced by our proprietary AI technology. By bridging the gap between medical guidance and daily decisions, we’re empowering individuals and families to make sustainable health choices that demonstrably improve both clinical outcomes and quality of life.

About The Role

The Provider Network Strategy Manager will lead the strategic development and day-to-day operations of the credentialing function for our medical nutrition therapy (MNT) telehealth organization. This role will oversee provider credentialing with health plans, credentialing staff, and credentialing processes, and develop strategy to expand the organization’s network relationships. The position requires deep understanding of both the operational and strategic aspects of healthcare credentialing in a telehealth environment using the MSO-PC model.

Note that this role is a hybrid role in LA or NYC, with a minimum expectation of 4 days per month at an office. For non-local candidates, relocation assistance will be considered.

What you’ll do

Strategic Leadership

• Develop and implement the organization’s network strategy, identifying priority markets, payers, and provider types based on business objectives
• Analyze market opportunities and regulatory requirements to determine optimal credentialing approaches by state
• Lead cross-functional collaboration with Clinical Operations, Product / Engineering, Business Development, Revenue Cycle, Legal, and Compliance teams to ensure alignment with business goals
• Create data-driven dashboards to track credentialing KPIs and revenue impact
• Partner with leadership to expand payer networks and provider roster in alignment with growth strategy
• Develops and articulates the overall credentialing strategy in alignment with organizational goals, providing guidance and expertise to other departments on credentialing implications.
• Leverages strong consultative abilities to understand the credentialing needs and challenges of various internal departments, ensuring seamless integration of credentialing processes with overall organizational objectives.

Operational Management

• Oversee the full credentialing lifecycle from initial application through primary source verification to maintenance and re-credentialing
• Manage credentialing staff, including work allocation, professional development, and performance evaluations
• Design and implement efficient credentialing workflows to reduce time-to-credential metrics
• Maintain comprehensive documentation of credentialing policies and procedures
• Ensure compliance with NCQA, URAC, health plan, and state-specific credentialing requirements
• Develop and maintain relationships with key contacts at insurance companies and health plans
• Design and oversee standardized credentialing workflows with clear ownership of steps and define protocols to minimize time-to-credential across all provider types
• Lead regular process audits and continuous improvement initiatives, identifying optimization opportunities through data analysis and implementing solutions that increase throughput while maintaining quality
• Report on the metrics of progress and success on credentialing processes
• Evaluate, select, and oversee the implementation of credentialing technology solutions that integrate seamlessly with the organization’s internal platform, billing systems, and reporting tools
• Collaborate with Product and Engineering teams to translate complex credentialing workflows into technical requirements, identifying opportunities for automation, AI-assisted verification, and data-driven prioritization
• Ensure all providers are properly configured in the Product with respect to licensure and credentialing
• Develop and oversee a NCQA-compliant delegated credentialing process (including policies, procedures, committee development, and auditing)
• Negotiate and implement delegated credentialing contracts
• Partner with internal departments to understand their credentialing requirements and challenges, offering tailored solutions during onboarding and ongoing maintenance
• Monitor internal and external satisfaction with credentialing processes, gathering feedback for continuous improvement

Communication & Authority

• Serve as or delegate the central point of contact and information funnel for all credentialing inquiries, ensuring consistent communication
• Act as the subject matter expert on all credentialing matters, including current status, processes, regulatory requirements, and strategic direction
• Provide leadership and decision-making authority for the credentialing team and related efforts
• Empower the credentialing team through delegation, mentorship, and performance management
• Develop and maintain relationships with key decision-makers and operational stakeholders, providing ongoing support

Budget & Cost Savings

• Develop, manage, and monitor the Credentialing Department budget, ensuring cost-effective operations
• Identify and implement cost-saving initiatives within the Credentialing Department
• Analyze credentialing trends and data to develop strategic recommendations for cost savings, compliance, and operational efficiency

Compliance & Quality

• Ensure adherence to all regulatory requirements related to provider credentialing and enrollment
• Establish quality control procedures to maintain data integrity across credentialing systems
• Prepare for and lead responses to audits from payers and accreditation organizations
• Stay current on evolving regulations and credentialing requirements across multiple states
• Implement continuous process improvement initiatives to enhance credentialing operations
• Experience with or ability to manage the complexities of compact licensure for Registered Dietitians (where applicable), ensuring compliance with state regulations and interstate agreements.

About You

• 5+ years of experience in healthcare credentialing, with at least 2 years in a management role
• Experience with telehealth and multi-state credentialing required; experience with credentialing MNT providers is preferred but not required
• Deep knowledge of CAQH, NCQA, and health plan credentialing requirements
• Thorough understanding of delegated credentialing standards, documentation requirements, and performance metrics
• Proven track record scaling credentialing operations during rapid growth
• Understanding of MSO-PC models and corporate practice of medicine considerations
• Familiarity with credentialing software platforms and database management
• Strong analytical and problem-solving skills
• Excellent interpersonal and communication abilities
• Bachelor's degree required; MBA or Master’s in Healthcare Administration or related field preferred
• CPCS, CPMSM, or other credentialing certification highly desirable

What You Get

• A full-time role at a competitive wage with significant equity
• Medical, dental, and vision benefits provided at no cost
• Option to participate in 401k plan
• Flexible work arrangements, including unlimited PTO
• Training, mentorship, and learning opportunities in a fast-paced, high-growth environment
• Opportunity to make a meaningful impact at a mission-driven company

Interested? How to Apply:

To apply, please send your resume (no cover letter required). If selected, you will be invited to a 30-minute phone screen to assess your overall experience. Successful candidates will then meet with additional team members for a more in-depth evaluation of technical skills, knowledge, and working style.

More About Season

Season recruits, employs, compensates, and promotes regardless of race, religion, sex, national origin, ethnicity, gender identity, disability, age, veteran status, and other protected statuses as required by law and company ethics.

The pay range for this role is: $110,000 - $130,000 USD per year (Hybrid in New York, NY or Los Angeles, CA).