Senior Credentialing Manager – Lead Compliance & Ops

Curana Health; United States; Teletrabalho; USD 110 000 - 145 000; Tempo integral

Resumo da oferta

Curana Health is seeking an experienced Credentialing Manager to lead our Professional Credentialing team and oversee end-to-end practitioner credentialing and recredentialing.

This role supports regulatory compliance, provider network growth, and efficient credentialing operations across a managed care environment, partnering with data management and IT to optimize workflows and reporting.

The position offers opportunities to drive process improvements and expand into new markets.

Qualificações

• Bachelor's degree or equivalent in healthcare or related field.
• Minimum of 7 years in a managed care or large health plan setting.
• 5+ years in provider credentialing and contracting with leadership experience.

Responsabilidades

• Lead the end-to-end practitioner credentialing and recredentialing process per CMS/NCQA/state rules.
• Manage a team of credentialing professionals and ensure timely turnaround.
• Monitor provider file inventory, workflows, and quality metrics.
• Develop tracking and reporting to reveal provider status and risks to leadership.
• Oversee credentialing communications, approvals, denials, and information requests.
• Collaborate with data management and IT to improve systems and integrations.

Conhecimentos

CMS/NCQA standards/requirements

Team leadership

Provider data management

Reporting & analytics

Process improvement

Formação académica

Bachelor's degree or equivalent

Ferramentas

CredentialStream

Excel

SharePoint

Descrição da oferta de emprego

Curana Health is seeking an experienced Credentialing Manager to lead our Professional Credentialing team and oversee end-to-end practitioner credentialing and recredentialing.

This role supports regulatory compliance, provider network growth, and efficient credentialing operations across a managed care environment, partnering with data management and IT to optimize workflows and reporting.

The position offers opportunities to drive process improvements and expand into new markets.