Sr Manager, Credentialing and Accreditation - remote opportunity
$96,600–$135,300 year
RemoteUnited States
Job Summary
Oversee credentialing and accreditation operations, managing staff and ensuring compliance with NCQA, URAC, and federal/state regulatory requirements. Lead new and existing market credentialing activities, including program delivery, workflow development, pre-delegation audits, and standards updates. Manage the Quality Management Committee, annual evaluations, and vendor oversight while producing key indicator reports on turnaround times. Coordinate cross-functional changes with operations, marketing, and client relations to improve inter-departmental communication and process improvements. Represent the team on cross-functional groups for new market rollouts and product development.
Required Qualifications
- Current, active, unrestricted state license in the clinical arts (e.g., RN or BSN)
- Minimum of 5+ years of experience in a health care operations or managed care role
- 4+ years of supervisory experience
- Operational experience within a health insurance environment
- Direct experience with accreditation/certification/audit activities
- Direct experience with the supervision and management of personnel
- Must exhibit excellent interpersonal skills and professionalism including strong verbal, telephonic and written communication skills
- Ability to work under pressure and have strong listening skills
- Demonstrable strategic thinking abilities
- Analytical with problem-solving aptitude
- Excellent PC skills including proficiency with MS Office software
- Strong attention to detail and accuracy
Desired Qualifications
- Bachelor's degree in healthcare administration or related field
- Experience in Credentialing operations and requirements, Utilization Management, and accreditation standards
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