Manager, Credentialing & Network Specialist

Credentialing & Enrollment Ownership:

• Own end-to-end provider credentialing and enrollment across Medicaid, Medicare, Medicare Advantage.
• Act as the primary internal coordinator for credentialing across providers, payers, and cross-functional teams.
• Lead credentialing readiness for new payer launches, expansions, and ongoing payer requirements.

Compliance, Audit Readiness & Workforce Standards:

• Ensure credentialing policies and documentation meet payer and regulatory requirements.
• Maintain audit-ready credentialing files and documentation to support payer reviews, compliance checks.
• Monitor and track clinician licenses, board certifications, and required documentation.

Community-Based Workforce Credentialing & Compliance:

• Manage credentialing / eligibility requirements for community-based roles.
• Build and maintain systems that track workforce readiness requirements such as certification status, training completion.

Credentialing Infrastructure Build:

• Build and continuously improve credentialing infrastructure.
• Identify bottlenecks and implement process improvements to reduce credentialing cycle times.
• Operate as a trusted cross-functional partner to Payer Partnerships, Implementation, Operations, and Clinical leaders.