Own the end-to-end credentialing and payer enrollment process for behavioral health providers across multiple states.
Manage internal credentialing onboarding for newly hired providers by collecting and validating required documentation.
Design and maintain credentialing and enrollment tracking systems to monitor application status, renewal timeliness, and enrollment milestones as the company scales.
Willow Health aims to significantly improve the mental health care experience by expanding affordable access to high-quality, evidence-based intensive behavioral health care. The co-founding team of Cityblock and Oscar alums has two decades of collective experience working in healthcare and healthcare tech, and they are backed by Andreessen Horowitz.
Responsible for credentialing and recredentialing of practitioner applicants.
Ensures the provider network meets regulatory criteria to minimize liability and maximize member safety.
Maintains confidentiality of practitioner information and performs detailed application reviews.
Curana Health is a national leader in value-based care, offering solutions to senior living communities and skilled nursing facilities. Founded in 2021, they serve 200,000+ seniors in 1,500+ communities across 32 states with a team of more than 1,000.
Enrolling practitioners in health plans in a timely and effective fashion.
Monitoring progress and ensuring timeliness of enrollment completion.
Maintaining provider enrollment goals for all divisions.
Pediatrix Medical Group provides specialized health care for women, babies, and children. Since 1979, Pediatrix has grown into a national, multispecialty medical group committed to coordinated, compassionate, and clinically excellent services.
Responsible for the maintenance of relevant provider data for use in network development and contracting, provider relations, marketing & communications, contracting, and more.
This role will also work with other network development teams to support provider data management across the CommonSpirit enterprise, including contracting and credentialing teams, to complete requests and support network operations.
Collect, validate, and maintain provider data to support marketing, provider relations, network contracting, credentialing across all lines of business.
Dignity Health Management Services Organization (Dignity Health MSO) aims to establish a system-wide integrated physician-centric, full-service management service organization structure. They offer various management and business services, leveraging economies of scale and leading efforts in developing Dignity Health’s Medicaid population health care management pathways.
Coordinate the end-to-end medical provider enrollment process.
Prepare and submit enrollment applications to Medicare, Medicaid, and other payers.
Maintain accurate provider data within internal systems to ensure consistency.
Curana Health is dedicated to radically improving the health, happiness, and dignity of older adults through value-based care. Founded in 2021, it has quickly grown to serve over 200,000 seniors in 1,500+ communities across 32 states with a team of 1,000+ clinicians and other professionals.
Execute non-delegated credentialing process for new and existing providers.
Serve as a point of contact for all insurance payor relationships.
Maintain accurate and up-to-date records of all credentialing activities.
Dental Care Alliance's mission is to advance the practice of dentistry by partnering with and supporting dental professionals to create a lifetime of healthy smiles. Headquartered in Sarasota, Florida, DCA supports over 400 allied practices and supports over 900 dentists across over 20 States.
Manage the end-to-end process of licensing applications.
Coordinate the initial credentialing and re-credentialing processes for licensed providers.
Maintain accurate and up-to-date records of all licensing and credentialing activities.
InStride Health delivers specialty anxiety and OCD care. They combine research-backed clinical care and innovative technology to eliminate the major problems with care today, and become the nation’s most trusted provider of pediatric anxiety and OCD care.
Manage complex provider roster creation, submission, and record reconciliation.
Oversee resolution of moderate-scope issues by prioritizing tasks.
Serve as main contact for roster inquiries, collaborating with internal teams and external payers.
Aledade empowers independent primary care practices to deliver better care and thrive in value-based care. Founded in 2014, they are the largest network of independent primary care in the country with a collaborative, inclusive, and remote-first culture.
Prepare complex prior authorization requests by identifying clinical guidelines for review.
Proactively obtain clinical information from prescribers to ensure all aspects of clinical guidelines are addressed.
Effectively use problem solving skills to identify gaps and resolve concerns.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. They offer full-service health benefit management solutions, and consolidate all claim administration-related workflows in one secure platform.
Negotiate pharmacy agreements across retail, mail, and quality-based channels.
Create and manage network contracting campaigns, analyzing performance metrics.
Work with analytics teams to assess network adequacy and compliance.
Jobgether is a company that uses AI to power the job application process. They ensure applications are reviewed quickly, objectively, and fairly against a role's core requirements.
Conduct research and provide problem-solving support to the Customer Service Department, Brokers and Sales.
Provide efficient, courteous, professional quality service to Groups, Plan personnel and Brokers/Sales in a timely manner.
Ensure compliance with organizational and regulatory requirements.
They promise to go the extra mile for their team and community. Capital Blue Cross values your professional and personal growth by investing heavily in training and continuing education.
Define and build Sprinter Health’s clinical pharmacy program.
Conduct virtual medication reconciliation and therapy reviews.
Advise patients on medication adherence, side effects, and safe use.
Sprinter Health is an innovative healthcare startup dedicated to providing high-quality, in-home and virtual care across the country. They employ a multidisciplinary team of clinicians, technologists, and operators and are backed by investors including a16z, General Catalyst, GV, and Accel.
Submit accurate enrollment applications to multiple public and private payers.
Manage enrollments across multiple states and provider types, ensuring timely follow-up.
Maintain up-to-date provider information in CAQH and resolve enrollment discrepancies.
Seven Starling is a virtual provider of women's behavioral health services, supporting every stage of motherhood. They combine therapy, peer support, and medication management with 94% of patients seeing improvement. They partner with OBGYN clinics and health plans to make care accessible.
Coordinate case management activities related to medication optimization, adherence, and therapeutic appropriateness
Collaborate with providers, PBMs, and pharmacy partners to support evidence-based medication use and access
Conduct member outreach, education, and follow-up to support adherence and understanding
Point C is a national third-party administrator (TPA) delivering customized self-funded benefit programs with local market presence. They focus on cost containment strategies with innovative solutions. They are driven by a clear and impactful mission.
Manage provider relationships and drive engagement within your assigned territory.
Execute strategic initiatives, including supporting providers and coordinating events.
Act as the primary point of contact for providers and community organizations.
Imagine Pediatrics is a tech-enabled, pediatrician-led medical group that reimagines care for children with special health care needs. They deliver 24/7 virtual-first and in-home medical, behavioral, and social care, working alongside families, providers, and health plans.
Act as the primary point of contact for incoming member calls and prior authorization inquiries.
Accurately advise callers on options for exception requests based on client benefit elections.
Efficiently triage incoming calls with professional phone etiquette from members, prescribers, and pharmacies.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. They manage health benefits for employers, TPAs, and health plans and are rebuilding trust in healthcare in the U.S.
Define and execute the long-term vision for credentialing and enrollment, transitioning from manual processes to a tech-enabled, scalable operation.
Oversee the end-to-end enrollment process for Medicare, Medicaid, and Commercial payers. Be the primary liaison for enterprise contract activations.
Lead the internal Credentialing Committee, presenting provider files and ensuring all primary source verifications (NPDB, OIG, SAM) are flawless.
Foodsmart is the leading telenutrition and foodcare solution, backed by a robust network of Registered Dietitians. Their platform is designed to foster healthier food choices, drive lasting behavior change, and deliver long-term health outcomes. At Foodsmart, their mission is to make nutritious food accessible and affordable for everyone, regardless of economic status.
Lead and nurture a dynamic team of clinical pharmacists and technicians.
Create and uphold robust policies and procedures for utilization management review.
Generate and deliver comprehensive reports on prior authorization metrics.
Judi Health is an enterprise health technology company providing solutions for employers and health plans, including pharmacy benefit management and health benefit management. Judi Health values diversity and provides equal employment opportunities to all employees and applicants.
Manage multiple channel interactions with excellent communication skills.
Effectively present and discuss products and services to providers.
Establish and maintain positive relationships with providers.
Capital BlueCross is an independent licensee of the Blue Cross Blue Shield Association. We are an equal opportunity employer committed to a culture of diversity and inclusion.
Develop and maintain a quality audit program for the Clinical Review Team.
Ensure high-quality reviews and adherence to regulatory requirements.
Deliver exceptional member, provider, and employee experiences.
SmithRx is a rapidly growing Health-Tech company that aims to disrupt the Pharmacy Benefit Management (PBM) sector using technology and customer service. The company has a mission-driven and collaborative culture, with hundreds of thousands of members onboarded since 2016.