Manager, Credentialing

Job not on LinkedIn

🔥 2 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Core Health LLC

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

⚕️ Healthcare Insurance

🌍 Social Impact

Healthcare • Healthcare Insurance • Social Impact

Core Health LLC is a Health Services Management company specializing in managing at-risk patients, including the elderly, disabled, and those eligible for Medicaid and Medicare-Medicaid programs. The company collaborates with integrated health systems, Medicare Advantage Plans, and Accountable Care Organizations to enhance patient care in their communities. They also operate Health Alliance Connect, an integrated care program focused on seniors and individuals with disabilities.

📋 Description

• Lead, coach, develop, and hold accountable a high-performing team of credentialing professionals • Establish credentialing roles, responsibilities, productivity standards, quality expectations, and performance goals • Own and continuously improve credentialing policies, protocols, standard operating procedures, workflows, tools, templates, and documentation standards • Establish consistent credentialing practices across hospitals, facilities, service lines, and geographic markets • Maintain knowledge of credentialing, recredentialing, privileging, licensing, certification, and related requirements • Establish and manage credentialing KPIs, service standards, dashboards, reporting mechanisms, and performance routines • Oversee quality assurance and audit programs • Analyze credentialing data and trends to identify barriers, inefficiencies, and improvement opportunities • Build relationships with clinicians, hospital medical staff offices, operations leaders, recruiting, payor enrollment, and other stakeholders • Serve as the senior operational escalation point for complex credentialing matters • Partner cross-functionally to support clinician onboarding, hospital implementations, operational readiness, and organizational growth • Optimize credentialing platforms, integrations, automation, reporting, and workflows • Provide hands-on operational support during critical business needs and significant implementations • Lead or participate in cross-functional initiatives related to clinician onboarding, credentialing, technology, compliance, and operational improvement

🎯 Requirements

• High School Diploma or GED required • Bachelor’s Degree in Healthcare related fields preferred • Certified Provider Credentialing Specialist (CPCS) preferred • 3-5 Years of Credentialing Management required • Experience with MS Outlook, Word, Excel, and MS Teams • Experience with credentialing software and Salesforce required • Strong knowledge of healthcare credentialing, privileging, recredentialing, licensing, certifications, and medical staff processes • Proficiency with Microsoft Office, credentialing platforms, workflow management systems, reporting tools, and related technology • Excellent verbal and written communication skills • Strong organizational skills and attention to detail

🏖️ Benefits

• Equal opportunity employer • Drug-free workplace • ADA compliance as applicable