HSCSN Mgr Cred Prov Data Mgmt

The Credentialing and Provider Data Manager is responsible for overseeing all aspects of provider credentialing, recredentialing and the integrity of provider data within the health plan. This includes ensuring compliance with federal and state regulations, accreditation standards (e.g., NCQA, CMS, DOH), and contractual obligations. The role provides leadership for credentialing and provider data management operations, including process development, data quality, delegated oversight, provider data management, provider directory management and audit readiness. The Manager will also serve as the point of contact for credentialing-related audits and ensure timely, accurate updates to provider directories and databases. The Manager supervises the Provider Data Specialist and Credentialing Coordinators. The Credentialing and Provider Data Manager is responsible for overseeing all aspects of provider credentialing, recredentialing and the integrity of provider data within the health plan. This includes ensuring compliance with federal and state regulations, accreditation standards (e.g., NCQA, CMS, DOH), and contractual obligations. The role provides leadership for credentialing and provider data management operations, including process development, data quality, delegated oversight, provider data management, provider directory management and audit readiness. The Manager will also serve as the point of contact for credentialing-related audits and ensure timely, accurate updates to provider directories and databases. The Manager supervises the Provider Data Specialist and Credentialing Coordinators. Minimum Education Bachelor's Degree (Preferred) Minimum Work Experience 7 years Credentialing experience (Required) And 5 years Supervisory or management experience (Required) Required Skills/Knowledge Excellent written and verbal communication skills Strong presentation skills In-depth knowledge of health plan and medical staff credentialing practices Strong familiarity with accreditation standards and regulatory frameworks (e.g., NCQA, JC, AAAHC, CMS, DHCF) Proven ability to improve process efficiency and implement system automation Experience with credentialing software and provider data systems Ability to interpret documents, licenses, certifications, and accrediation standards Ability to manage multiple priorities in a fast-paced environment Required Licenses and Certifications Certified Provider Credentialing Specialist (CPCS) 1 Year (Required) Job Functions Organizational Accountabilities Organizational Accountabilities (Managers) Leadership Excellence Collaboration Leadership Skills Supervisory Responsibilities Blood Borne Pathogen Exposure Protected Health Information Access Level Working Environment Physical Requirements Travel Requirements Minimum Education Bachelor's Degree (Preferred) Minimum Work Experience 7 years Credentialing experience (Required) And 5 years Supervisory or management experience (Required) Required Skills/Knowledge Excellent written and verbal communication skills Strong presentation skills In-depth knowledge of health plan and medical staff credentialing practices Strong familiarity with accreditation standards and regulatory frameworks (e.g., NCQA, JC, AAAHC, CMS, DHCF) Proven ability to improve process efficiency and implement system automation Experience with credentialing software and provider data systems Ability to interpret documents, licenses, certifications, and accrediation standards Ability to manage multiple priorities in a fast-paced environment Required Licenses and Certifications Certified Provider Credentialing Specialist (CPCS) 1 Year (Required) Job Functions Organizational Accountabilities Organizational Accountabilities (Managers) Leadership Excellence Collaboration Leadership Skills Supervisory Responsibilities Blood Borne Pathogen Exposure Protected Health Information Access Level Working Environment Physical Requirements Travel Requirements

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