Medical Credentialing Manager

Medical Credentialing Manager

A respected healthcare organization is seeking an experienced Credentialing Manager to lead credentialing operations and provider data management for its Long Beach, California team. In this leadership role, you'll oversee the full credentialing lifecycle—including provider onboarding, recredentialing, enrollment support, and data integrity—while ensuring compliance with regulatory requirements and health plan standards. You'll also collaborate with cross-functional leaders to optimize processes, strengthen audit readiness, and drive operational excellence across the credentialing function.

Key Responsibilities

• Lead and mentor the credentialing and provider data team, setting daily priorities and ensuring efficient operations.

• Oversee provider onboarding, recredentialing, payer enrollment, and privileging activities to support a seamless provider experience.

• Ensure compliance with accreditation standards, delegated credentialing requirements, and applicable state and federal regulations.

• Review credentialing files, provider rosters, and supporting documentation to maintain complete, accurate, and up-to-date records.

• Monitor team productivity, turnaround times, and workflow performance, proactively resolving issues that impact service levels.

• Prepare for internal and external audits by conducting routine reviews, identifying gaps, and implementing corrective actions.

• Partner with leadership to enhance credentialing policies, reporting capabilities, and operational workflows.

• Safeguard provider data integrity across systems to support accurate reporting, compliance, and downstream operational needs.

• Benefits: Comprehensive Health, Dental, and Vision insurance, 401(k) retirement plan, and Paid Sick Time.

Qualifications

• Bachelor’s degree in Healthcare Administration, Business Administration, or a related discipline.

• At least 5 years of experience in managed care credentialing, including 1 or more years in a lead or supervisory capacity.

• Strong understanding of delegated credentialing, payer enrollment requirements, recredentialing practices, and provider file management.

• Knowledge of state, federal, regulatory, and accreditation expectations related to credentialing operations.

• Experience using credentialing platforms and maintaining provider databases; familiarity with MD-Staff is preferred.

• Ability to manage multiple priorities, monitor compliance, and support audit preparation in a healthcare environment.

• Certification in credentialing is considered an advantage.

• Background in healthcare managed care settings is strongly preferred.

• 36.12 - 48.01 USD / Hourly