Quality Improvement & Credentialing Lead

Northeast Georgia Health System; Gainesville (GA); On-site; USD 85,000 - 110,000; Full time

Job summary

Northeast Georgia Health System is seeking a qualified professional to lead the annual Quality Improvement workplan and credentialing program. You will manage committee activities, respond to regulatory standards inquiries, and coordinate audits and provider credentialing processes across the organization.

The role requires strong problem solving, organizational skills, and experience with NCQA, JCAHO/URAC/NCQA standards; site visits and data-driven reporting are essential components of this

Qualifications

• Bachelor’s degree or equivalent; 6–8 years of relevant experience.
• Minimum 6 years in a large group practice or managed care setting with Quality Improvement and credentialing.
• Licensure or certifications (as applicable).

Responsibilities

• Implement the Quality Improvement and Credentialing Programs; draft annual workplans and obtain approval.
• Coordinate data collection, reviews, and reports for QI activities.
• Ensure NCQA credentialing standards compliance and on-site reviews.
• Lead credentialing verification for providers and monitor delegated agreements.
• Conduct site visits, respond to provider issues, and manage patient satisfaction surveys.
• Maintain organized files, policies, and documentation; update procedures as needed.

Skills

Problem solving

Detail oriented

Organized

Verbal & written communication

Regulatory standards knowledge

Word & Excel proficiency

Education

Bachelor’s degree or equivalent

Tools

Microsoft Word

Microsoft Excel

Job description

Northeast Georgia Health System is seeking a qualified professional to lead the annual Quality Improvement workplan and credentialing program. You will manage committee activities, respond to regulatory standards inquiries, and coordinate audits and provider credentialing processes across the organization.

The role requires strong problem solving, organizational skills, and experience with NCQA, JCAHO/URAC/NCQA standards; site visits and data-driven reporting are essential components of this