Senior Manager, Credentialing

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

About Altais: At Altais, we’re on a mission to improve the healthcare experience for everyone—starting with the people who deliver it. We believe physicians should spend more time with patients and less time on administrative tasks. Through smarter technology, purpose-built tools, and a team-based model of care, we help doctors do what they do best: care for people. Altais includes a network of physician-led organizations across California, including Brown & Toland Physicians, Altais Medical Group Riverside, and Family Care Specialists. Together, we’re building a stronger, more connected healthcare system.

About the Role

This role is responsible for the strategic direction and operational oversight of the credentialing function to support, develop, manage and monitor processes and procedures for the credentialing, re-credentialing, expirables data management and delegated functions for all our Health Plan Partners for all lines of business. This role manages the credentialing program for Altais affiliated entities, including employed clinicians, vendors providing clinical services on the MSOs behalf, as well as MSO services for any other medical group or IPA purchasing from Altais Health Solution including application management and primary source verification completion. This role is also responsible for the administrative aspects for all credentialing functions needed to meet medical group, health plan and accrediting body requirements including but not limited to the National Committee for Quality Assurance (NCQA), the Centers for Medicare & Medicaid Services (CMS), and the Department of Managed Health Care (DMHC). This role, in combination with the Credentialing team, is to maintain procedures, processes and internal & vendor systems in line with all regulation and compliance requirements. This role has key vendor management oversight responsibilities to ensure our contracted vendor systems and services are delivering services and capabilities as expected. Additionally, this role will oversee the interdependencies between departments, consistently maintaining knowledge and understanding of the impact to providers and how that may affect overall business operations and financial outcomes. At the senior level, this role owns the credentialing policy portfolio, the development and maintenance of departmental training documentation, preparation and facilitation of the Credentialing Committee, pre-delegation and ongoing oversight audits of sub-delegated entities, and the development of key performance indicators and executive reporting for the function.

You will focus on:

• Providing leadership / coaching to the credentialing team staff, ensuring function initiatives and deliverables are complete and accurate in a timel
• Responsible for processing credentialing applications accurately and promptly in accordance with Credentialing policies and procedures and in full compliance with all regulations with a continued focus on delivery of a high-quality product with the greatest level of efficiency
• Manages audit preparation of materials and files necessary to comply with external audits by payors and/or governmental agencies
• Manages relationships with health plan delegation oversight teams
• Manages peer review physician documentation for Clinical Advisory Group
• Develops, maintains, and annually reviews credentialing training documents, desktop procedures, and onboarding materials for the credentialing team
• Conduct audits of the credentialing database, confirming accurate input of provider data, and verifying accuracy of modifications made to the database and downstream impacts to other reporting tools and functions
• Owns Credentialing Database system modifications and workflows development and implementation
• Manages vendor systems and services performance
• Leads credentialing committee effectiveness in partnership with the Chief Medical Officer
• Prepares and facilitates the Credentialing Committee, including agenda development, file preparation and presentation, meeting minutes, and follow-through on committee determinations
• Conducts pre-delegation and annual oversight audits of sub-delegated entities, evaluates compliance against NCQA, CMS, and DMHC requirements, issues corrective action plans, and monitors remediation to closure
• Owns the credentialing policy portfolio, including annual review, revision, and approval routing of policies and procedures to maintain alignment with regulatory and accreditation standards
• Develops key performance indicators for the credentialing function and creates recurring dashboards and ad hoc reporting for executive leadership
• Develops functional, market level, and/or site strategy, plans, production and/or organizational priorities for Altais Health affiliated groups as well as clients purchasing MSO services
• Identifies and resolves technical, operational and organization problems outside own team
• Other duties as assigned

Skills, Experience & Education You Bring

Bachelor’s degree or equivalent to 4 year university degree, preferably in healthcare related field of study.

10+ years professional experience working in credentialing, preferably in a managed care setting required.

2+ years of employee / team management experience.

Requires advanced knowledge of credentialing software and CRM tools plus expert working knowledge of NCQA, CMS Conditions of Participation, Medicare Advantage requirements, and DMHC regulations, including delegation oversight and audit readiness.

Required Certifications Must be eligible to take National Association Medical Staff Services (NAMSS), Certified Provider Credentialing Specialist exam within 18 months of employment NAMSS Credentialing certification preferred.

Compensation

The Base Salary for this position is $89,250 – 107,100/year In addition, we provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.

Benefits

• Excellent medical, vision, and dental coverage
• 401k savings plan with a company match
• Flexible time off and 9 Paid Holidays

You Share Our Mission & Values

• Compassion We act with empathy and a deep respect for the challenges faced by physicians and their patients. Our work is driven by a genuine commitment to improving lives and ensuring that care is delivered with dignity, understanding, and humanity.
• Community We foster a culture of collaboration--with physicians, patients across the healthcare ecosystem, and among our teams. By building strong, trusted relationships, we create a unified community focused on advancing patient care and physician well-being.
• Leadership We lead with integrity and vision, setting the standard for excellence in physician support and healthcare innovation. Through collaboration and expertise, we empower others to lead, drive change, and shape the future of care.
• Excellence We are relentlessly focused, results-driven, and accountable for delivering measurable value to physicians and the patients they serve. Our high standards reflect our commitment to excellence, operational discipline, and continuous improvement.
• Agility We embrace change as a constant and respond swiftly to the evolving needs of the healthcare industry. With flexibility and forward-thinking, we adapt, innovate, and act decisively to keep physicians at the forefront.

Altais values the contribution each Team Member brings to our organization.

Requirements for equal employment opportunity: All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity or disability status and any other classification protected by Federal, State and local laws.

An outside certain context about background checks: External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance.

Please refer to our ‘CPRA Privacy Notice for California Employees and Applicants’ to learn how we collect and process your personal information when you apply for a role with us.

If you’re a big thinker, bold innovator, and fiercely motivated to drive change, consider joining our team. We are dedicated to creating exceptional healthcare experiences by building tools that cultivate the health and well-being of physicians, patients, and the clinical community.