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Job description
Provide oversight of direct and delegated credentialing processes
Ensure accreditation and regulatory compliance
Lead credentialing operations, including database maintenance, workflow improvement, file and report management, records and communication policies, and staff hiring and supervision
Support compliance through document review, delegated-entity audits, sanctions/complaints review, and site reviews
Define and monitor credentialing KPIs and SLAs, including turnaround time, quality audits, and file completeness
Drive continuous improvement
Serve as escalation point and partner for providers, staff leadership, HR/recruiting, and compliance/legal
Own committee governance, including agendas, minutes, decision tracking, and action follow-through
Identify credentialing risks and trends and implement mitigation plans
Manage vendors and CVOs, including contracts, performance, and issue resolution
Establish data governance and deliver routine reporting to leadership
Coordinate provider lifecycle workflows
Train stakeholders and standardize criteria and workflows across entities
Requirements
Proven people leadership, including hiring, coaching, and performance management
Working knowledge of The Joint Commission, NCQA, CMS Conditions of Participation, and applicable state/federal requirements
Experience with delegated credentialing oversight and audit readiness
Experience with corrective action planning
Proficiency with credentialing software/CVO platforms, databases, and reporting tools
Strong data quality discipline
Ability to develop and manage policies, workflows, and metrics
Ability to lead process improvement and change management
Strong judgment and discretion
Ability to maintain confidentiality with sensitive peer review and credentialing information
Availability to support committee meetings and deadlines
10+ years in medical staff services/credentialing
Bachelor’s degree preferred (or equivalent experience)
CPCS or CPMSM required
Must be based in the United States
Must be authorized to work in the United States without sponsorship, now or in the future
Core Competencies
Demonstrates expertise in credentialing operations, including oversight of processes, compliance with regulatory standards, and management of performance metrics. Proven ability to lead teams, implement process improvements, and maintain data governance in a healthcare environment.
Highest-signal resume keywords
Credentialing Oversight
Regulatory Compliance
Data Governance
People Leadership
CPCS or CPMSM Certification
Hard Skills
Credentialing Software
Database Management
Workflow Improvement
Performance Management
Corrective Action Planning
KPI Monitoring
Audit Readiness
Document Review
Risk Identification
Policy Development
Soft Skills
Strong Judgment
Discretion
Coaching
Confidentiality
Collaboration
Certifications & Qualifications
CPCS
CPMSM
Industry Keywords
The Joint Commission
NCQA
CMS Conditions of Participation
Medical Staff Services
Credentialing KPIs
Credentialing Risks
Delegated Credentialing
Tools & Technologies
CVO Platforms
Reporting Tools
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Worksite address
new york, NY, 10261, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.