Lead Director, Credentialing Operations

Lead Director, Credentialing Operations

We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

The Lead Director, Credentialing Operations oversees the Credentialing Verification Organization (CVO) and is accountable for the overall delivery of credentialing services including production, quality audit, reporting, ongoing monitoring and process improvement for the business operation. Maintain and validate the credentialing data for all network providers for multiple lines of business. Ensure all provider information is accurately recorded and maintained to provide a compliant and quality network of providers who are treating Aetna members.

Aligns policies and procedures for the Credentialing Operations department with organizational goals. Delivers on financial, operational, and service requirements while providing leadership and direction through multiple managers and vendors, by developing priorities and setting direction.

Key Responsibilities

• Oversee operational management of Commercial, Medicare, Medicaid credentialing operations, as well as ongoing monitoring of all providers.
• Manage a team of 100 employees through multiple managers.
• Oversee on-shore and off-shore vendor support tied to business operations to align resources to support inventory management and provide oversight of partner performance through quality and timeliness initiatives.
• Contribute to planning and administration of company programs and initiatives that promote the Credentialing Operations agenda.
• Accountable for department initiatives and objectives in partnership with stakeholders and leadership.
• Implement organizational policies, goals, and objectives based on best practices in the field.
• Build and develop strong functional operations management team through formal training, diverse assignments, coaching, communication, mentoring and performance management, and mentor team members to foster talent strategy and succession planning.
• Cultivate and manage relationships with various internal business partners.
• Ensure all Credentialing policies and procedures are executed consistently across the business operation and support alignment with accreditation agencies and regulatory bodies.
• Administer audit procedures for maintaining accurate and compliant provider credentialing data for contractual compliance, and network directory listing purposes.
• Experience with exploring solutions with automation, bots, AI, and other tools to drive exceptional performance in a highly visible operational environment.
• Create and deliver process improvement strategies to address internal trends and meet organizational vision and commitments on an ongoing basis.
• Drive change management through the organization to support competitive and changing environment.
• Lead integration and administration of credentialing databases, software, and other data sources and create strategies for continuous improvement.
• Control resources to deliver financial results and objectives within established budget parameters.

Required Qualifications

• 7+ years directly related experience in Healthcare Operations with a production focus
• Adept at execution and delivery (planning, delivering, and supporting) skills
• Advance working knowledge of business systems, applications, and tools supporting credentialing, provider data and inventory management.
• Proven ability to work collaboratively at all levels.
• Ability to effect change.
• Exercises sound judgment and demonstrates analytical/data-driven decision-making skills.

Preferred Qualifications

• Experience in a matrixed environment which includes outsourcing to external vendors.
• Project management experience.

Education

• Bachelor's degree or equivalent work experience

Pay Range

The typical pay range for this role is:

$ - $

This pay range represents the base hourly rate or base…