Credentialing Program Lead

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🔥 2 minutes ago

🌺 Hawaii – Remote

🌺 Hawaii – Remote

💵 $121.6k - $143k / year

⏰ Full Time

🟠 Senior

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Modern Health

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2017

🤝 B2B

⚕️ Healthcare Insurance

🧘 Wellness

💰 $74M Series D on 2021-02

B2B • Healthcare Insurance • Wellness

Modern Health is a comprehensive mental health care platform that provides a global standard for equitable services worldwide. They offer a wide range of mental health support for employees, family care, and healthcare providers through self-guided tools and crisis care, aiming to boost productivity and prevent burnout. Modern Health partners with employers, consultants, and health plans to integrate mental health benefits into the workplace, addressing long-term needs, reducing absenteeism, enhancing operational efficiency, and improving well-being. Their evidence-based solutions cater to a wide array of mental health concerns, promoting personalization and accessibility to culturally centered care globally.

📋 Description

• Lead and optimize Modern Health’s credentialing program, including initial credentialing, recredentialing, ongoing monitoring, exception handling, and documentation standards • Lead the administration and operations of the Credentialing Committee, including agenda development, case preparation, primary source verification review, documentation management, meeting facilitation, decision tracking, and follow-up activities. • Ensure credentialing and recredentialing activities are conducted in accordance with organizational policies, accreditation standards, regulatory requirements, and the enterprise quality governance structure. • Improve and scale policies, SOPs, controls, and governance processes aligned with regulatory and accreditation requirements • Define and refine program goals, SLAs, metrics, and reporting to monitor timeliness, quality, audit readiness, and operational performance • Streamline workflows for licensure, sanctions, exclusions, malpractice, expirables, renewals, and issue resolution • Serve as a key liaison across Provider Operations, Clinical Quality, Compliance, Legal, and Recruiting/Onboarding to strengthen provider credentialing oversight, mitigate organizational risk, support audit readiness, and drive accountability to Quality Committee priorities. • Identify process, tooling, and vendor opportunities that improve scalability, visibility, and provider experience • Serve as the credentialing SME for audits, escalations, governance reviews, and credentialing-related provider status decisions • Support day-to-day credentialing operations while driving a more scalable future-state model

🎯 Requirements

• 5+ years of experience leading and optimizing credentialing programs, provider operations, provider enrollment, licensing, or a related healthcare operations function • Experience administering Credentialing Committee activities, provider governance processes, audits, and regulatory reviews. • Knowledge of credentialing and recredentialing standards, including NCQA, URAC, state regulatory requirements, and delegated credentialing arrangements. • Experience improving credentialing infrastructure, policies, workflows, controls, or operating models in a growing environment • Experience with credentialing software, provider data management systems, primary source verification tools, CAQH, NPDB, provider lifecycle management platforms and credentialing documentation requirements. • Experience supporting audits, accreditation readiness, delegated credentialing oversight, or similar compliance programs • Strong program management, analytical, and cross-functional communication skills • Comfortable balancing strategic process improvement with hands-on operational execution. • Applicants must be able to maintain work authorization for the duration of employment without employer sponsorship or employer-provided training plans or attestations (including, for example, the Form I-983 required for STEM OPT). Immigration sponsorship is not available for this position.

🏖️ Benefits

• Medical / Dental / Vision / Disability / Life Insurance • High Deductible Health Plan with Health Savings Account (HSA) option • Flexible Spending Account (FSA) • Access to coaches and therapists through Modern Health's platform • Generous Time Off • Company-wide Collective Pause Days • Parental Leave Policy • Family Forming Benefit through Carrot • Family Assistance Benefit through UrbanSitter • Professional Development Stipend • 401k • Financial Planning Benefit through Origin • Annual Wellness Stipend to use on items that promote your overall well being • New Hire Stipend to help cover work-from-home setup costs • ModSquad Community: Virtual events like active ERGs, holiday themed activities, team-building events and more • Monthly Cell Phone Reimbursement