Credentialing Manager

Curana Health

. Lead and oversee the full practitioner credentialing and recredentialing process in alignment with CMS, NCQA, state, Medicaid, and insurance requirements .

Posted 10/12/2026full-timeRemote • United StatesSeniorLeadWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates extensive experience in leading provider credentialing operations, managing team performance, and implementing process improvements in compliance with CMS, NCQA, and Medicaid standards. Proficient in utilizing credentialing management systems and data analysis tools to enhance operational efficiency and maintain high-quality credentialing workflows.

Highest-signal resume keywords

Provider Credentialing Operations ManagementCredentialStream ProficiencyStrong Knowledge of CMS and NCQA StandardsHigh-Volume Credentialing Workflow ManagementReporting and Analytical Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Provider CredentialingCredentialing Policies DevelopmentProcess ImprovementData ManagementQuality AssuranceExcel ProficiencySQL ProcessesCredentialing Systems ManagementOperational Deadline ManagementPerformance Tracking

Soft Skills

Excellent Communication SkillsTeam LeadershipInterpersonal SkillsTraining and Support

Tools & Technologies

CredentialStreamMicrosoft OfficeSharePoint

Industry Keywords

Managed Care OrganizationHealth PlanCredentialing StandardsMedicaid ProgramsProvider File Inventory

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

Lead and oversee the full practitioner credentialing and recredentialing process in alignment with CMS, NCQA, state, Medicaid, and insurance requirements
Manage and support a team of credentialing professionals responsible for professional provider credentialing
Monitor provider file inventory, team workflows, production benchmarks, quality assurance, and credentialing turnaround times
Establish tracking and reporting processes for provider status, team performance, credentialing volume, and potential risks
Develop, implement, and maintain credentialing policies and procedures
Identify inefficiencies and lead process-improvement initiatives
Maintain accurate provider status information in provider data management and credentialing systems
Oversee credentialing correspondence, approvals, denials, information requests, and provider follow-up
Partner with data management and IT teams on credentialing system integration and operational improvements
Research and resolve credentialing issues and prevent recurrence
Maintain Credentialing Committee documentation, manage meeting agendas, and present credentialing recommendations
Communicate credentialing status changes to providers and internal stakeholders
Oversee provider outreach, application submission, documentation, and internal quality-assurance processes
Train and support team members, Medical Directors, and health plan partners on credentialing processes and tools

Requirements

What you’ll need

Bachelor’s degree or an equivalent combination of education and relevant healthcare experience
Minimum of 7 years of experience in a managed care organization or large health plan environment
Minimum of 5 years of direct provider credentialing and contracting experience
Demonstrated experience leading provider credentialing operations and managing team performance
Strong knowledge of physician credentialing standards and requirements established by CMS, NCQA, state agencies, and Medicaid programs
Experience using CredentialStream or a comparable credentialing platform
Proficiency with Excel and SharePoint
Proven experience managing high-volume credentialing workflows, provider file inventory, quality metrics, and operational deadlines
Experience building, improving, or repairing credentialing processes and tracking systems
Strong reporting and analytical skills, including the ability to track and interpret credentialing trends and performance
Excellent written and verbal communication skills, with the ability to work effectively across organizational levels and with external partners
Proficiency with Microsoft Office applications and credentialing management systems
Experience working for a national or regional managed care organization or large health plan (preferred)
Experience performing SQL-related processes or working with SQL-supported reporting (preferred)
Interest in using AI, automation, bots, or agents to improve operational efficiency (preferred)
Demonstrated success implementing process improvements in a complex, high-volume credentialing environment (preferred)
Must be able to work in the United States; visa sponsorship is unavailable