Remote Leader: Provider Data & Credentialing

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

Benefits offered by this job

Competitive pay

Health insurance

401K

Stock purchase plan

Tuition reimbursement

Paid time off

Flexible schedules

Job summary

Centene Corporation is seeking a Credentialing Operations Manager to lead credentialing and provider data management across multiple business units in the United States. The role ensures NCQA, DHHS, CMS, and other regulatory compliance, overseeing credentialing, provider setup, and sanctions monitoring.

The position requires a Bachelor's degree and 5+ years of management experience in healthcare operations, with a track record of cross-functional leadership and process improvements to reduce

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 and supervising staff.

Responsibilities

• Oversee the credentialing and re-credentialing of all physicians, mid-level practitioners and organizational providers according to plan specifications for multiple business units.
• Oversee provider setup processes ensuring accurate and timely setup for claims payment, member assignment and directory display.
• Ensure compliance with NCQA and DHHS credentialing requirements and participate in activities related to plan NCQA accreditation.
• Collaborate with health plans and various departments on network expansion efforts, large claims and contract amendment projects and related initiatives.
• Identify process improvement opportunities to decrease cost, improve quality and increase efficiency within the department.
• Review and update departmental policies and procedures to ensure compliance with NCQA, CMS and other regulatory agencies.
• Monitor Medicaid and Medicare sanctioning reports to ensure compliance with HCFA requirements regarding exclusion of provider participation.
• Facilitate Credentialing Committee activities and serve on Quality Improvement Committees, when needed.

Skills

Management

Provider data management

Credentialing

Healthcare operations

Education

Bachelor’s degree or equivalent experience

Job description

Centene Corporation is seeking a Credentialing Operations Manager to lead credentialing and provider data management across multiple business units in the United States. The role ensures NCQA, DHHS, CMS, and other regulatory compliance, overseeing credentialing, provider setup, and sanctions monitoring.

The position requires a Bachelor's degree and 5+ years of management experience in healthcare operations, with a track record of cross-functional leadership and process improvements to reduce