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Director - Credentialing
Director - CredentialingAstrana Health, Inc. • Monterey Park, CA, US
Director - Credentialing

Director - Credentialing

Astrana Health, Inc. • Monterey Park, CA, US
11 hours ago
Job type
  • Full-time
  • Quick Apply
Job description

Description

As Director of Credentialing, you will have oversight and accountability for a national Credentialing Department. You will collaborate closely with the Operations Leadership Team and cross-functional departments to lead and / or participate in high-impact initiatives that optimize performance and support enterprise-wide growth. This role blends operational efficiency, compliance rigor, and leadership. The ideal candidate is a dynamic problem-solver with strong communication skills, a passion for compliance, and a proven ability to lead in fast-paced environments.

Our Values :

  • Put Patients First
  • Empower Entrepreneurial Provider and Care Teams
  • Operate with Integrity & Excellence
  • Be Innovative
  • Work As One Team

What You'll Do

Operational Leadership for National Credentialing Functions :

  • Oversee credentialing operations, including direct supervision of staff and vendor management.
  • Set and achieve departmental KPIs and budget targets.
  • Implement technology, tools, and processes to drive productivity and cost-efficiency, while maintaining high quality and compliance.
  • Align staffing model with annual Enterprise growth and G&A targets.
  • Foster strong relationships with key internal and external stakeholders.
  • Lead agenda setting and follow-up actions for credentialing committee meetings in alignment with regulatory standards. Compliance Adherence
  • Streamline sub-delegation processes and ensure compliance with applicable state, federal, NCQA, & Health Plan regulations.
  • Manage DMHC & health plan audits and any resulting CAPs in close partnership with the Compliance team.
  • Maintain up-to-date knowledge of credentialing standards, such as NCQA.
  • Ensure policies and operating procedures are reviewed & updated at least annually to align with accreditation standards and health plan requirements.

    • Project & Relationship Management :

  • Oversee onboarding timelines and quality for new acquisitions, clients, and contracts.
  • Represent Enterprise in Health Plan and Client JOCs, including accurate presentation of data.

    • Operational Efficiency Improvements :

  • Identify and lead initiatives to improve workflows, systems, and cross-functional collaboration.
  • Present process improvement strategies and drive implementation.
  • Monitor post-implementation results and refine approaches as needed.

    • Qualifications

  • Bachelor’s degree in business administration, health administration or related field (Master’s preferred).
  • CPMSM or CPSC professional certification.
  • 10+ years of credentialing operations experience, including 8+ years of managing a credentialing department or credentialing verification organization (CVO).
  • Expertise in NCQA, URAC, The Joint Commission, and / or other relevant standards and accreditations.
  • Strong analytical and problem-solving skills.
  • Proven success in fast-paced environments with a focus on speed and precision.
  • Self-directed and collaborative, with ability to influence diverse stakeholders (in person and virtually).
  • Exceptional organizational skills; able to manage multiple projects simultaneously.
  • Executive presence with ability to quickly build credibility and partner with business leaders and providers.
  • Extensive experience with managed care organizations (e.g., medical group operations, MSO’s, IPA’s, etc.) and / or delegated credentialing entities.

    • You’re great for this role if :

  • You are a self-starter who thrives in dynamic environments.
  • You are passionate about improving healthcare.
  • You enjoy taking ownership and can motivate others to deliver quality and efficient outcomes.

    • Environmental Job Requirements and Working Conditions

  • Our organization follows a hybrid work structure where the expectation is to work onsite two days a week. The home site for this position is 1600 Corporate Center Dr, Monterey Park, CA 91754.
  • The base pay range for this role is $130,000-155,000. This salary range represents our national target range for this role.

    • Astrana Health (NASDAQ : ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.

    Our platform currently empowers over 20,000 physicians to provide care for over 1.7 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.

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