UCLA Health is seeking a Credentialing Manager to lead the credentialing operations for all lines of business within our Managed Care Operations team. This role is responsible for the development, implementation, and oversight of credentialing processes to ensure compliance with state, federal, accreditation, and contractual requirements. The Credentialing Manager will directly supervise a team of five credentialing specialists and will manage daily operations, performance standards, and continuous process improvements to ensure credentialing efficiency and accuracy.
The Credentialing Manager will oversee the MCO credentialing program lifecycle, including provider applications, primary source verifications, expiring credentials, audits, and delegation oversight. This role serves as a key liaison between internal departments to include Credentialing Verification Office (CVO), Centralized Credentialing Unit (CCU), Medical Staff Office (MSO), health plan partners, accreditation agencies, and provider networks, providing subject matter expertise on credentialing and regulatory matters.
Key Responsibilities: Lead, supervise, and develop credentialing staff. Manage all credentialing and recredentialing operations ensuring timely processing and regulatory compliance. Oversee ongoing monitoring of provider credentials and regulatory requirements. Lead departmental audits, including corrective action plans and delegation oversight. Ensure compliance with NCQA, CMS, DMHC, DHCS, and other regulatory agencies. Maintain and enhance credentialing systems, policies, and procedures. Coordinate credentialing committees, present cases, and ensure appropriate documentation. Serve as the primary contact for health plans, regulatory agencies, and provider organizations. Collaborate with cross-functional teams to support onboarding, training, process improvement, and data integrity. Ability to travel/attend off-site meetings and conferences
Salary Range: $76,200 – $158,800/Annually