Quality Improvement & Credentialing Lead

Northeast-Georgia-Health-System; Gainesville (GA); On-site; USD 90,000 - 120,000; Full time

Job summary

Northeast Georgia Health System seeks a seasoned Quality Improvement and Credentialing Leader to develop and sustain the annual QI workplan, chair committees, and ensure NCQA accreditation readiness. The role drives data collection, on-site reviews, and regulatory compliance, partnering with HP team, Risk Management, and Infection Control to advance patient safety and provider performance.

Applicants should have a bachelor's degree with 6-8 years' experience in large group practice or managed

Qualifications

• Educational requirements: Bachelor's Degree or equivalent with six to eight years of relevant experience.
• Minimum six years in a large group practice or managed care setting responsible for Quality Improvement and credentialing activities.
• Knowledge of regulatory standards (JCAHO for PPOs, URAC and NCQA).
• Detail- and deadline-oriented with strong follow-up and communication skills.

Responsibilities

• Responsible for implementing the Quality Improvement Program and the Credentialing Program; drafts annual workplans.
• Evaluates and revises the Quality Improvement program at least annually; presents to the Quality Improvement Committee.
• Coordinates data collection for QI workplans and prepares quarterly reports.
• Updates policy and procedure manuals governing QI and credentialing activities.
• Manages credentialing of providers through primary source verification and NCQA readiness.

Skills

Assessment and problem solving

Detail and deadline oriented

Effective verbal and written comms

Knowledge of regulatory standards (JCA

Education

Bachelor's Degree or equivalent in related field

Tools

Word

Excel

Job description

Northeast Georgia Health System seeks a seasoned Quality Improvement and Credentialing Leader to develop and sustain the annual QI workplan, chair committees, and ensure NCQA accreditation readiness. The role drives data collection, on-site reviews, and regulatory compliance, partnering with HP team, Risk Management, and Infection Control to advance patient safety and provider performance.

Applicants should have a bachelor's degree with 6-8 years' experience in large group practice or managed