Manager, Credentialing and Network Specialist

Manager, Credentialing & Network Specialist (National)

Remote (Full Time)

Compensation: $110,000 - $120,000 (per year)

Zócalo Health is a tech-enabled, community-oriented primary care organization serving people who have historically been underserved by the one-size-fits-all healthcare system. We partner with health plans, providers, and community organizations to deliver culturally competent primary care, behavioral health, and social care.

Our model is built for populations with high medical and social complexity, where fragmented care drives poor outcomes and unnecessary cost. We combine local, community-based teams with virtual care and modern technology to deliver coordinated, whole-person care where members live and receive support.

Founded in 2021, Zócalo Health is backed by leading healthcare and mission-aligned investors and is scaling rapidly across states and populations. We are building a durable care platform designed to perform in constrained healthcare environments and to lead the shift toward accountable, value-based care.

The Manager, Credentialing & Network Specialist will join Zócalo Health during a period of rapid growth and increasing operational complexity. This role exists to help scale and execute a community-oriented primary care model that delivers measurable outcomes for high-need members and health plan partners.

As part of a fast-growing team, you will be responsible for building and operating Zócalo Health's credentialing and enrollment infrastructure across California and new markets (New York, Maryland, Washington, and future states). This person ensures Zócalo's clinical and community-based workforce is credentialed, compliant, and payer‑ready so we can launch and expand health plan partnerships without delays.

This role is both hands‑on and operationally strategic: you will directly own credentialing execution while also building the repeatable systems (SOPs, policies, forms, tracking mechanisms, and readiness workflows) that allow Zócalo to scale across payers, products, and states. You will act as the internal expert and point person for credentialing requirements spanning clinicians and community-based care teams (including CHWs), partnering closely with Implementation, Operations, and Payer Partnerships to ensure "ready‑to‑bill" network status across all health plan contracts.

This position reports to the Head of Payer Contracting and Strategy.

The Manager, Credentialing will contribute in the following ways:

• Own end‑to‑end provider credentialing and enrollment across Medicaid, Medicare, Medicare Advantage, and D‑SNP payers, including maintenance of CAQH and payer systems, tracking of statuses, renewals, and effective dates to ensure uninterrupted network participation.
• Act as the primary internal coordinator for credentialing across providers, payers, and cross‑functional teams, resolving issues and driving timely completion.
• Lead credentialing readiness for new payer launches, expansions, and ongoing payer requirements, ensuring standards and timelines are met to accelerate time‑to‑revenue and maintain payer trust.
• Partner with Implementation and Operations to confirm credentialing completion prior to handoffs and go‑lives.

• Ensure credentialing policies and documentation meet payer and regulatory requirements (e.g., CMS, NCQA, state Medicaid agencies, and payer‑specific standards).
• Maintain audit‑ready credentialing files and documentation to support payer reviews, compliance checks, and Medicare Advantage/D‑SNP oversight.
• Monitor and track clinician licenses, board certifications, and required documentation (as applicable), including renewal workflows and proactive outreach.

• Manage credentialing / eligibility requirements for community‑based roles relevant to Medicaid and CalAIM delivery (e.g., CHWs), including certification pathways and ongoing compliance tracking.
• Build and maintain systems that track workforce readiness requirements such as…