Credentialing Program Lead

Credentialing Program Lead The Role

Modern Health is looking for a Credentialing Program Lead to lead and optimize our credentialing program for a growing provider network.

This is an individual contributor role to start. You will serve as the primary owner of credentialing program execution and continuous improvement, strengthening the policies, workflows, recredentialing standards, audit readiness, reporting, and governance already in place to support a scalable, compliant provider network.

This is a high‑impact role for someone who is equal parts program lead, operator, and subject matter expert. You are comfortable improving existing processes, identifying gaps and opportunities, and translating regulatory requirements into practical, scalable workflows while driving cross‑functional execution without direct people management.

This role is eligible for remote work within the USA, with the exception of Hawaii.

• Lead and optimize Modern Health’s credentialing program, including initial credentialing, recredentialing, ongoing monitoring, exception handling, and documentation standards
• Lead the administration and operations of the Credentialing Committee, including agenda development, case preparation, primary source verification review, documentation management, meeting facilitation, decision tracking, and follow‑up activities
• Ensure credentialing and recredentialing activities are conducted in accordance with organizational policies, accreditation standards, regulatory requirements, and the enterprise quality governance structure
• Improve and scale policies, SOPs, controls, and governance processes aligned with regulatory and accreditation requirements
• Define and refine program goals, SLAs, metrics, and reporting to monitor timeliness, quality, audit readiness, and operational performance
• Streamline workflows for licensure, sanctions, exclusions, malpractice, expirables, renewals, and issue resolution
• Serve as a key liaison across Provider Operations, Clinical Quality, Compliance, Legal, and Recruiting/Onboarding to strengthen provider credentialing oversight, mitigate organizational risk, support audit readiness, and drive accountability to Quality Committee priorities
• Identify process, tooling, and vendor opportunities that improve scalability, visibility, and provider experience
• Serve as the credentialing SME for audits, escalations, governance reviews, and credentialing‑related provider status decisions
• Support day‑to‑day credentialing operations while driving a more scalable future‑state model

• 5+ years of experience leading and optimizing credentialing programs, provider operations, provider enrollment, licensing, or a related healthcare operations function
• Experience administering Credentialing Committee activities, provider governance processes, audits, and regulatory reviews
• Knowledge of credentialing and recredentialing standards, including NCQA, URAC, state regulatory requirements, and delegated credentialing arrangements
• Experience improving credentialing infrastructure, policies, workflows, controls, or operating models in a growing environment
• Experience with credentialing software, provider data management systems, primary source verification tools, CAQH, NPDB, provider lifecycle management platforms and credentialing documentation requirements
• Experience supporting audits, accreditation readiness, delegated credentialing oversight, or similar compliance programs
• Strong program management, analytical, and cross‑functional communication skills
• Comfortable balancing strategic process improvement with hands‑on operational execution
• Applicants must be able to maintain work authorization for the duration of employment without employer sponsorship or employer‑provided training plans or attestations (including, for example, the Form I‑983 required for STEM OPT). Immigration sponsorship is not available for this position

• Experience in digital health, telehealth, behavioral health, or a multi‑state provider network environment
• Experience with credentialing platforms, provider data systems, or vendor oversight
• Certified Provider Credentialing…