Senior Manager, Credentialing Operations

4004 Aetna Medicaid Administrators; United States; On-site; USD 83,000 - 183,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Paid Time Off

Retirement Savings

Wellness Programs

Job summary

CVS Health is seeking a Senior Manager, Credentialing Operations to lead the Credentialing Verification Organization, ensuring accuracy, integrity and compliance of provider credentialing data across lines of business, delivering timely credentialing decisions to support member access to care.

You will drive operational excellence, data-driven insights, and continuous process improvement, partnering with Network Management, Provider Relations, Provider Services, and Health Delivery teams to

Qualifications

• 5+ years in provider data management or credentialing.
• 3+ years leading and developing teams.
• Experience in credentialing operations.
• Knowledge of Medicare, Medicaid, and/or Commercial lines.
• Strong analytical and decision-making skills.
• Ability to influence stakeholders and drive results.
• Strong written and verbal communication.

Responsibilities

• Leads a unit delivering credentialing services.
• Sets strategic direction for Credentialing Operations.
• Analyzes performance metrics against objectives.
• Implements strategies to boost quality, compliance, service.
• Advises internal and external stakeholders.
• Leads audits and corrective actions.
• Partners across networks to improve outcomes.
• Drives continuous improvement and accountability.

Skills

Credentialing ops

Leadership

Data analysis

Stakeholder influence

Regulatory knowledge

Education

Bachelor's degree

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

The Senior Manager, Credentialing Operations is the leader of critical functions within the Credentialing Verification Organization (CVO) and is accountable for the delivery of credentialing services, including production, quality, reporting, ongoing monitoring, and continuous process improvement. This role ensures the accuracy, integrity, and compliance of provider credentialing data across multiple lines of business, supporting the development and maintenance of a high-quality provider network. This leader plays a key role in advancing health plan objectives by driving operational excellence, regulatory compliance, quality outcomes, and provider experience. Through collaboration with cross-functional partners, the Senior Manager leverages data-driven insights, process optimization, and strategic execution to improve credentialing performance, enhance service delivery, and ensure timely, accurate credentialing decisions that support member access to care.

Key Responsibilities

• Leads a business services unit that delivers credentialing services in support of organizational objectives.
• Establishes and communicates strategic direction for Credentialing Operations and ensures processes align with enterprise goals and priorities.
• Analyzes operational performance metrics and key initiatives to evaluate progress against business objectives and identify opportunities for improvement.
• Develops and implements strategies that enhance operational effectiveness, quality, compliance, and service delivery.
• Serves as a trusted advisor to internal and external stakeholders on credentialing operations, business reviews, and related initiatives.
• Leads audit activities, including issue identification, corrective action planning, error remediation, and rebuttal management.
• Reviews audit findings for accuracy and provides guidance on issues with significant business or regulatory implications.
• Partners with Network Management, Provider Relations, Provider Services, Health Delivery teams, and other cross-functional stakeholders to address provider-related issues and improve operational outcomes.
• Drives continuous improvement initiatives that streamline processes, reduce risk, and enhance the provider and customer experience.
• Fosters a culture of accountability, collaboration, innovation, and high performance.

Required Qualifications

• Minimum of 5 years of experience in provider data management, provider network operations, provider relations, credentialing, or a related healthcare operations function.
• Minimum of 3 years of experience leading and developing teams.
• Experience working in credentialing operations.
• Knowledge of and experience supporting Medicare, Medicaid, and/or Commercial Health Insurance lines of business.
• Strong analytical, problem-solving, and decision-making skills.
• Demonstrated ability to influence stakeholders and drive results across cross-functional teams.
• Strong written and verbal communication skills.

Preferred Qualifications

• Experience leading operational transformation or continuous improvement initiatives.
• Experience working within a Credentialing Verification Organization (CVO) environment.
• Experience utilizing data and metrics to drive operational performance and business decisions.
• Proven ability to manage multiple priorities in a fast-paced, highly regulated environment.

Education

Bachelor's degree or equivalent work experience

Pay Range

Pay Range The typical pay range for this role is: $82,940.00 - $182,549.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 11/09/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Our Work Experience is the combination of everything that’s unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's the ?maybe we need to keep? I think we should keep all but not sure.

Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.