Senior Manager, Credentialing & Peer Review Lead

DeKalb Health; Alameda (CA); Hybrid; USD 181,000 - 272,000; Full time

Job summary

Alameda Alliance seeks a Sr. Manager, Peer Review and Credentialing to oversee credentialing for physicians and providers. Youll supervise staff, coordinate with vendors, and ensure compliance with NCQA, CMS, and related agencies across credentialing processes.

Youll lead audits, improve efficiency, and collaborate with the Chief Medical Officer on significant malpractice cases and sanctions prior to peer review. Strong regulatory knowledge and leadership are essential.

Qualifications

• BA/BS degree or equivalent credentialing experience.
• NAMSS CPCS and/or CPMSM certification required.
• Knowledge of CMS, DHCS, DMHC, NCQA standards.

Responsibilities

• Oversee credentialing and peer review staff for compliance and timely processing.
• Coordinate with credentialing vendors (Cactus, CVO, CAQH) and audit reports.
• Develop and implement credentialing policies and procedures.
• Ensure ongoing regulatory monitoring and annual audits.

Skills

Credentialing leadership

Regulatory knowledge

Interpersonal skills

Education

BA/BS Degree

NAMSS CPCS/CPMSM certification

Tools

Microsoft Office

Access

Job description

Alameda Alliance seeks a Sr. Manager, Peer Review and Credentialing to oversee credentialing for physicians and providers. Youll supervise staff, coordinate with vendors, and ensure compliance with NCQA, CMS, and related agencies across credentialing processes.

Youll lead audits, improve efficiency, and collaborate with the Chief Medical Officer on significant malpractice cases and sanctions prior to peer review. Strong regulatory knowledge and leadership are essential.