Credentialing and Regulatory Operations Manager

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $72.6k - $115.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

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Circle Medical

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2015

💼 Consulting

🛡️ Insurance

📦 Logistics

💰 Equity Crowdfunding - Circle Medical on 2019-03

Consulting • Insurance • Logistics

Circle Medical is a telemedicine company that provides primary care and specialty services through a secure app and a network of board-certified providers. They offer virtual and in-person visits for ADHD, mental health, gender-affirming care, hormone therapy, sleep care, weight loss, and general primary care, accept many PPO insurance plans, and provide transparent pricing and same/next-day availability. The platform integrates scheduling, medical records, prescriptions, and insurance verification to deliver consumer-focused, convenient healthcare.

📋 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