Senior Credentialing Leader for Health Plans

Altais Health Solutions; California (MO); Hybrid; USD 89,000 - 107,000; Full time

Benefits offered by this job

Medical, vision, dental coverage

401k with company match

9 paid holidays

Job summary

Altais Health Solutions is seeking a senior leader to drive the credentialing function, ensuring accurate processing, regulatory compliance, and audit readiness across MSO and health plan partners. The role includes policy ownership, training development, and executive reporting.

You will oversee the credentialing program for employed clinicians, vendors, and affiliated entities, coordinating with NCQA, CMS, and DMHC standards. Strong vendor management and cross-team collaboration are essential.

Qualifications

• Bachelor’s degree or equivalent to 4 year university, preferably in healthcare
• 10+ years professional experience in credentialing
• 2+ years of employee / team management experience
• Advanced knowledge of credentialing software and CRM tools plus NCQA, CMS, DMHC regulations
• NAMSS certification preferred (eligible to take exam within 18 months)

Responsibilities

• Provide leadership and coaching to the credentialing team to meet deadlines
• Process credentialing applications in full compliance with policies and regulations
• Prepare materials for external audits by payors or government agencies
• Manage relationships with health plan delegation oversight teams
• Oversee vendor systems and credentialing databases for accuracy
• Lead Credentialing Committee activities with the Chief Medical Officer
• Develop and maintain credentialing training materials and procedures
• Create dashboards and reporting for executive leadership

Skills

Leadership

Credentialing software

NCQA knowledge

CMS/DMHC knowledge

NAMSS certification

Education

Bachelor’s degree or equivalent

Tools

CRM tools

Job description

Altais Health Solutions is seeking a senior leader to drive the credentialing function, ensuring accurate processing, regulatory compliance, and audit readiness across MSO and health plan partners. The role includes policy ownership, training development, and executive reporting.

You will oversee the credentialing program for employed clinicians, vendors, and affiliated entities, coordinating with NCQA, CMS, and DMHC standards. Strong vendor management and cross-team collaboration are essential.