Credentialing Manager

Description
UCLA Health is seeking a Credentialing Manager to lead the credentialing operations for all lines of business within our Managed Care Operations team. This role is responsible for the development, implementation, and oversight of credentialing processes to ensure compliance with state, federal, accreditation, and contractual requirements. The Credentialing Manager will directly supervise a team of five credentialing specialists and will manage daily operations, performance standards, and continuous process improvements to ensure credentialing efficiency and accuracy.

The Credentialing Manager will oversee the MCO credentialing program lifecycle, including provider applications, primary source verifications, expiring credentials, audits, and delegation oversight. This role serves as a key liaison between internal departments to include Credentialing Verification Office (CVO), Centralized Credentialing Unit (CCU), Medical Staff Office (MSO), health plan partners, accreditation agencies, and provider networks, providing subject matter expertise on credentialing and regulatory matters.

Key Responsibilities:

• Lead, supervise, and develop credentialing staff.
• Manage all credentialing and recredentialing operations ensuring timely processing and regulatory compliance.
• Oversee ongoing monitoring of provider credentials and regulatory requirements.
• Lead departmental audits, including corrective action plans and delegation oversight.
• Ensure compliance with NCQA, CMS, DMHC, DHCS, and other regulatory agencies.
• Maintain and enhance credentialing systems, policies, and procedures.
• Coordinate credentialing committees, present cases, and ensure appropriate documentation.
• Serve as the primary contact for health plans, regulatory agencies, and provider organizations.
• Collaborate with cross-functional teams to support onboarding, training, process improvement, and data integrity.
• Ability to travel/attend off-site meetings and conferences

Salary Range: $76,200 - $158,800/Annually

Job Qualifications
Qualifications

• Ability to travel/attend off-site meetings and conferences, when necessary
• Minimum of five years previous experience in Credentialing working for a complex and diversified health plan, IPA, or other managed care organization - Required
• Minimum of three years' experience managing personnel with at least two years supervising credentialing personnel - Required
• Bachelor's degree in healthcare administration or other related field or a combination of equivalent education, training and experience.
• CPMSM or CPCS certification preferred.
• In depth knowledge of healthcare industry regulatory agencies, credentialing and provider directory standards including but not limited to CMS, NCQA, DMHC, DHCS, and HICE.
• Extensive understanding and experience using credentialing systems including the flow of credentialing and provider demographic information.
• Demonstrated computer skills; proficient with Microsoft Windows applications including but not limited to Excel, Word, Teams and Outlook.
• Demonstrated software skills in MD Staff [Preferred]
• Familiarity with EPIC Tapestry

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