Credentialing and Regulatory Operations Manager

🕒 August 29

🇺🇸 United States – Remote

💵 $72.6k - $115.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

👻 Ghost score 0%

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Circle Medical - a UCSF Health Affiliate

WebsiteLinkedInAll Job Openings

11 - 50 employees

Founded 2018

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

Circle Medical is a healthcare service provider offering convenient and accessible primary care through video and in-person appointments. As an affiliate of UCSF Health, the company is focused on providing comprehensive care, including ADHD treatment, gender-affirming care, mental health support, sleep care, and much more. Circle Medical emphasizes a patient-friendly approach, allowing patients to verify insurance and book appointments easily via their app, ensuring they receive timely and appropriate care. The service is known for delivering top-rated care with a network of over 400 active providers across multiple states in the U. S.

📋 Description

• Own the 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 of education, training, licensure, board certification, DEA, sanctions, and work history • Oversee maintenance of supervising/collaborating physician relationships and agreements • Liaise with providers, supervising physicians, clinical leadership, regulatory agencies, and internal departments • Partner with Compliance, Legal, Revenue Cycle, Provider Operations, and Clinical Leadership on onboarding, payer enrollment, and go-live readiness • Coordinate credentialing information for payer enrollment, revalidation, and re-credentialing • Develop, implement, and maintain credentialing policies, procedures, and workflows • Conduct internal audits and participate in accreditation surveys, audits, and regulatory reviews • Lead, coach, and develop direct reports • Design and optimize team workflows • Serve as subject matter expert and escalation point for complex operational issues • Escalate credentialing, licensing, supervision, or compliance risks • Own credentialing systems and tooling, including Modio, Symplr, Helix, or similar • Manage credentialing cycles, expirations, and renewals • Define and monitor operational metrics • Develop dashboards, reports, and tracking mechanisms • Produce insights and reporting for leadership decisions, capacity planning, and process improvements

🎯 Requirements

• Bachelor’s degree in healthcare administration, business administration, or related field (or equivalent experience) • 3+ years of progressive experience in provider credentialing, licensing, or medical staff services • 2+ years of supervisory or management experience • In-depth knowledge of credentialing standards (NCQA, Joint Commission, CMS) • Strong understanding of provider credentialing, privileging, and licensing requirements • Strong leadership and team management skills • Exceptional attention to detail and organizational abilities • Ability to interpret complex regulations and apply them operationally • Excellent written and verbal communication skills • Proficiency in credentialing software and Google applications • Ability to manage multiple priorities and meet deadlines in a fast-paced environment • Applicants must be legally authorized to work in the country where the role is based at the time of application

🏖️ Benefits

• Flexible vacation • Sick leave • 12 statutory holidays • Medical insurance • Dental insurance • Vision insurance • Disability insurance • Life insurance • Mental health programs • Employee Assistance Program (EAP) • RRSP/401(k) program with company match • Annual reimbursement for eligible training and professional programs

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