Strategic Remote Credentialing & Regulatory Operations Lead

Circle-Medical

United States

On-site

USD 73,000 - 115,000

Full time

14 days+

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Benefits offered by this job

Health Insurance

Dental Insurance

Vision Insurance

Disability Insurance

Life Insurance

401(k) with company match

Paid Time Off

Job summary

Circle Medical is seeking a Credentialing and Regulatory Operations Manager to lead credentialing, licensure, and privileging for a nationwide virtual-first care platform. This role oversees staff, ensures regulatory compliance, and partners with compliance, legal, and clinical leadership to align onboarding and payer enrollment with go-live readiness.

The ideal candidate has 3+ years in credentialing with supervisory experience, and knowledge of NCQA, Joint Commission, and CMS standards.

Qualifications

Bachelor’s degree in healthcare administration, business administration, or related field (or equivalent experience).
3+ years of provider credentialing, licensing, or medical staff services experience.
2+ years of supervisory or management experience.
In-depth knowledge of credentialing standards (NCQA, Joint Commission, CMS).
Strong leadership and team management skills.
Proficiency with credentialing software and Google applications.
Experience with multi-state licensing and large provider networks.
Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) preferred.

Responsibilities

Own end-to-end strategy and execution of provider credentialing, re-credentialing, supervising physician management, privileging, and licensing at scale.
Ensure compliance with CMS, NCQA, Joint Commission, state licensing boards, and payer-specific requirements.
Oversee primary source verification including education, training, licensure, board certification, DEA, sanctions, and work history, with clear quality controls.
Oversee the ongoing maintenance of supervising/collaborating physician relationships and agreements.
Serve as primary liaison with providers, supervising physicians, clinical leadership, regulatory agencies, and internal departments.
Partner with Compliance, Legal, Revenue Cycle, Provider Operations, and Clinical Leadership to align credentialing timelines with onboarding, payer enrollment, and go-live readiness.
Coordinate credentialing information required for payer enrollment, revalidation, and re-credentialing.
Develop, implement, and maintain credentialing policies, procedures, and workflows.
Conduct internal audits to ensure accuracy, completeness, and regulatory compliance.
Prepare for and participate in accreditation surveys, audits, and regulatory reviews.
Stay current on changes in credentialing regulations, accreditation standards, and payer requirements.
Maintain accurate supervising physician agreements and related documentation.
Lead, coach, and develop direct reports, setting clear performance expectations and quality standards.
Design and optimize team workflows to improve turnaround times, scalability, and accuracy.
Serve as a subject matter expert and escalation point for complex credentialing and supervising physician operational issues.
Escalate credentialing, licensing, supervision, or compliance risks promptly to appropriate leadership.
Own credentialing systems and tooling (Modio, Symplr, Helix or similar), ensuring data integrity and audit readiness.
Proactively manage credentialing cycles, expirations, and renewals to prevent provider downtime.
Define and monitor key operational metrics (turnaround times, aging, compliance gaps, provider readiness).
Develop and maintain dashboards, reports, and tracking mechanisms for credentialing status, expiration dates, outstanding documentation, and compliance risks.
Produce insights and reporting that inform leadership decisions, capacity planning, and process improvements.