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Credentialing Program Lead
Location
Hawaii
Posted
2 days ago
Salary
$121.6K - $143K / year
Seniority
Senior
Job Description
Credentialing Program Lead
Modern Health
• 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
Job 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
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