Credentialing Operations Manager
Listed on 2026-07-30
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IT/Tech
Business Systems & Technology Analysis, IT Business Analyst, Change Management
SUMMARY
The Credentialing Operations Manager is responsible for overseeing and optimizing key credentialing, licensing and privileging operational processes and the systems that enable them. This role drives efficiency, scalability, and continuous improvement by aligning operations and business processes with technology solutions. In addition, the manager will carry credentialing responsibilities as assigned by the Director and partner across the department’s functions to enhance performance, ensure compliance, and deliver an optimized physician credentialing experience.
GeneralHours of Work
Monday
- Friday (Days)
Exempt (Salaried)
Department/UnitCorporate
- Clinical
Director, Medical Staff Services
ESSENTIAL FUNCTIONS- Designs, documents, and implements standardized workflows and procedures
- Manages the designed processes to ensure optimal performance across the department
- Identifies inefficiencies and lead process improvement initiatives (Lean, Six Sigma, automation)
- Establishes and tracks KPIs (cycle time, quality, throughput, cost)
- Ensures processes are scalable, compliant, and aligned with business goals
- Serves as primary business owner for operational systems and tools (MD Staff)
- Oversees system configuration, workflows, and enhancements
- Partners with IT and vendors on upgrades, integrations, and issue resolution
- Ensures system reliability, user adoption, and data integrity
- Reports and analyses:
Generate detailed reports highlighting discrepancies, access patterns, and areas for improvement - Continuous monitoring and evaluation: regularly audit database activities and to detect anomalies, unauthorized access, or suspicious behavior
- Manages user access, roles, and system governance
- Acts as a liaison between business stakeholders, IT, and operations
- Translates business requirements into process and system solutions
- Supports training, communication, and adoption of new tools/processes
- Aligns priorities across departments to drive outcomes
- Serves as the primary business owner for the system and its data
- Defines system purpose, scope, and business requirements
- Ensures the system supports operational and strategic objectives
Optimizes organizational and business unit utilization - Supervises a small team of Licensing & Credentialing Specialists
- Ensures compliance with organizational policies, security standards, and regulatory requirements
- Approves system access, roles, and permissions
- Participates in audits, risk assessments, and compliance reviews
- Ensures proper data classification and handling
- Monitors system performance, availability, and user satisfaction
- Escalate issues impacting business operations
- Processes applications as required to support team workload demands.
- Performs primary source verification activities as needed to meet team workload requirements.
- Coordinates mail operations, preparing and sending documents via Fed Ex for provider review and completion, and maintaining efficient workflow processes.
QUALIFICATIONS:
The individual must be able to work the hours specified above. To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed above are representative of the knowledge, skills, and/or abilities required to perform the essential functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions, so long as the accommodations do not cause undue hardship to the employer.
EDUCATION and/or EXPERIENCE- Bachelor’s degree in healthcare, Business Administration, Information Technology, or a related field required.
- 7+ years of experience in Operations, process improvement, or transformation along with systems and tools ownership required.
- Experience with credentialing software deployment in a hospital or telemedicine environment.
- Strong understanding of business processes supported by the system and knowledge of information security,…
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