Remote Credentialing & Provider Data Manager

Centene Corporation; North Carolina; Hybrid; USD 88,000 - 158,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules (remote/hybrid

Job summary

Centene Corporation is seeking a senior leader to manage the credentialing and provider data management operations across multiple business units. The role ensures compliance with NCQA, DHHS, CMS and other regulatory standards, while driving process improvements and staff performance.

Responsibilities include overseeing credentialing activities, provider setup, and policy updates, with collaboration across health plans on network initiatives.

Qualifications

• Bachelor's degree in related field or equivalent experience.
• 5+ years of combined management and provider data management, credentialing or healthcare operations experience.
• Experience leading cross-functional teams on large scale projects.

Responsibilities

• Oversee credentialing and re-credentialing of physicians, mid-level practitioners and organizational providers.
• Oversee provider setup processes for claims payment, member assignment, and directory display.
• Ensure compliance with NCQA, CMS, DHHS, and other regulatory requirements; support NCQA accreditation activities.
• Collaborate with health plans and departments on network expansion, large claims, and contracting projects.
• Identify process improvements to reduce costs and improve quality and efficiency.
• Review and update departmental policies to ensure regulatory compliance.
• Monitor sanctioning reports to ensure HCFA compliance.
• Facilitate Credentialing Committee activities and participate in Quality Improvement Committees.

Skills

Leadership

Provider data management

Regulatory compliance

Healthcare operations

Education

Bachelor's degree

Job description

Centene Corporation is seeking a senior leader to manage the credentialing and provider data management operations across multiple business units. The role ensures compliance with NCQA, DHHS, CMS and other regulatory standards, while driving process improvements and staff performance.

Responsibilities include overseeing credentialing activities, provider setup, and policy updates, with collaboration across health plans on network initiatives.