Provider Operations Manager - Credentialing

Job DescriptionA bit about this role:

On the Provider Operations team, we are responsible for credentialing the providers and facilities contracting with our health plan. We built our credentialing program from the ground up, and it credentials providers compliantly in industry-leading timeframes. That lets us build new networks quickly, show operational excellence to our providers, and keeps provider data current and accurate.

In our stage of growth, we are focused on implementing AI initiatives and expanding the responsibilities of our offshore team to make our operations faster, more efficient, and ready to scale. We’re looking for a Manager of Provider Operations who is a hands-on operator. You’ll be just as comfortable digging into work queues and untangling a messy case as you are redesigning a workflow or rethinking how a process could run with AI. Priorities will shift, and you’ll shift with them.

This is an ideal role for a results-driven leader who is mission driven, process oriented, data obsessed, and energized by change.

Your responsibilities and impact will include:

• Supporting day-to-day credentialing operations, including working queues yourself, unblocking complex cases, and driving best-in-class turnaround times and quality.
• Leading the effort to capture our operational knowledge in clear, usable SOPs and building a central documentation library that stays current as processes change.
• Helping manage and develop our offshore team, including training, documentation, and quality and productivity monitoring, with the goal of owning the offshore relationship over time.
• Partnering on offshore transitions by identifying work that can move offshore and supporting smooth handoffs without disrupting turnaround times or compliance.
• Assessing operational pain points and using data to size opportunities and build the business case for new solutions using data insights, including quantifying the impact of AI solutions, tech improvements, and offshore transitions before and after they launch.
• Creating and implementing AI solutions that make operations more efficient and enable scale, partnering with product and engineering where needed and testing, measuring, and refining what you build.
• Playing a key role in our 2027 CVO vendor transition, including workflow mapping, requirements, testing, and cutover, and helping monitor vendor performance once live.
• Becoming an expert in our internal systems and tools so you can troubleshoot issues and propose clear improvements to system logic.
• Owning key operational metrics, building reporting that surfaces trends and bottlenecks, and using data to guide decisions.
• Ensuring credentialing operations remain compliant with CMS, AAAHC, and state requirements as processes and tools evolve.
• Partnering cross-functionally with internal leadership, network and contracting teams, providers, vendors, and offshore partners.