Credentialing Manager

Job not on LinkedIn

🔥 1 hour ago

🇺🇸 United States – Remote

⏰ Full Time

🟠 Senior

🔴 Lead

👔 Manager

👻 Ghost score 10%

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Curana Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

🤝 B2B

⚕️ Healthcare Insurance

Healthcare • B2B • Healthcare Insurance

Curana Health is a healthcare provider focused on senior primary care and on-site clinical services in skilled nursing and senior living communities. The company partners with operators, payors, and Medicare Advantage plans to implement value-based care models, offering physician-led care teams, medical director services, care coordination (including RPM and APCM), behavioral health, and palliative care. Curana emphasizes reducing hospital readmissions, falls, and polypharmacy while improving resident satisfaction through integrated, community-based care supported by technology and payor partnerships.

📋 Description

• Lead and oversee the full practitioner credentialing and recredentialing process in alignment with CMS, NCQA, state, Medicaid, and insurance requirements • Manage and support a team of credentialing professionals responsible for professional provider credentialing • Monitor provider file inventory, team workflows, production benchmarks, quality assurance, and credentialing turnaround times • Establish tracking and reporting processes for provider status, team performance, credentialing volume, and potential risks • Develop, implement, and maintain credentialing policies and procedures • Identify inefficiencies and lead process-improvement initiatives • Maintain accurate provider status information in provider data management and credentialing systems • Oversee credentialing correspondence, approvals, denials, information requests, and provider follow-up • Partner with data management and IT teams on credentialing system integration and operational improvements • Research and resolve credentialing issues and prevent recurrence • Maintain Credentialing Committee documentation, manage meeting agendas, and present credentialing recommendations • Communicate credentialing status changes to providers and internal stakeholders • Oversee provider outreach, application submission, documentation, and internal quality-assurance processes • Train and support team members, Medical Directors, and health plan partners on credentialing processes and tools

🎯 Requirements

• Bachelor’s degree or an equivalent combination of education and relevant healthcare experience • Minimum of 7 years of experience in a managed care organization or large health plan environment • Minimum of 5 years of direct provider credentialing and contracting experience • Demonstrated experience leading provider credentialing operations and managing team performance • Strong knowledge of physician credentialing standards and requirements established by CMS, NCQA, state agencies, and Medicaid programs • Experience using CredentialStream or a comparable credentialing platform • Proficiency with Excel and SharePoint • Proven experience managing high-volume credentialing workflows, provider file inventory, quality metrics, and operational deadlines • Experience building, improving, or repairing credentialing processes and tracking systems • Strong reporting and analytical skills, including the ability to track and interpret credentialing trends and performance • Excellent written and verbal communication skills, with the ability to work effectively across organizational levels and with external partners • Proficiency with Microsoft Office applications and credentialing management systems • Experience working for a national or regional managed care organization or large health plan (preferred) • Experience performing SQL-related processes or working with SQL-supported reporting (preferred) • Interest in using AI, automation, bots, or agents to improve operational efficiency (preferred) • Demonstrated success implementing process improvements in a complex, high-volume credentialing environment (preferred) • Must be able to work in the United States; visa sponsorship is unavailable