Credentialing Manager - Infusion Pharmacy
6 days ago
San Diego
Job Description Overview The Credentialing Manager leads and oversees enterprise-wide credentialing and recredentialing operations for pharmacies, ambulatory infusion suites, and nurse practitioner services across multiple states. This role ensures full compliance with federal, state, accreditation, and payor-specific credentialing requirements in a highly regulated healthcare environment, while supporting organizational growth and operational excellence Schedule: Monday - Friday, 8:30am-5pm - Remote We Offer • Medical, Dental & Vision Benefits plus, HSA & FSA Savings Accounts, • Supplemental Coverage – Accident, Critical Illness and Hospital Indemnity Insurance, • 401(k) Retirement Plan, • Company paid Life and AD&D Insurance, Short-Term and Long-Term Disability, • Employee Discounts, • Tuition Reimbursement, • Paid Time Off & Holidays Responsibilities • Manages day-to-day credentialing workflows for providers and facilities, including onboarding, recredentialing, and change management, • Supervises, mentors, and develops credentialing specialists to ensure accuracy, timeliness, and consistency across all markets, • Serves as the subject matter expert on credentialing standards related to home infusion therapy, specialty pharmacy, and ambulatory services, • Maintains compliance with CMS, state Medicaid agencies, commercial payors, and accreditation bodies (e.g., ACHC, URAC, The Joint Commission, NABP), • Partners with contracting, revenue cycle, compliance, legal, and clinical leadership to support new business, acquisitions, and market expansion, • Oversees credentialing for multi-state licensure, DEA registrations, NPI enrollment, and specialty pharmacy-specific requirements, • Monitors credentialing metrics, turnaround times, and payor performance; identify risks and implement process improvements, • Leads audits, corrective action plans, and payor inquiries related to credentialing and enrollment, • Ensures credentialing data integrity within credentialing systems, payor portals, and internal provider databases, • Develops, maintains, and updates credentialing policies, procedures, and internal controls, • Scales credentialing operations to support acquisitions, de novos, and rapid geographic expansion, • Standardizes credentialing practices across regions while adapting to state-specific regulatory nuances, • Drives automation, technology adoption, and workflow efficiencies to reduce cycle time, administrative burden, and revenue leakage, • Provides executive-level reporting on credentialing status, risks, capacity constraints, and operational readiness, • Acts as a strategic advisor on credentialing implications for new service lines, care models, and clinical programs, • Supervisory Responsibility: Yes Qualifications • Bachelor’s Degree in healthcare administration, business, or a related field, • Minimum of five (5) years health care experience, • Extensive experience in healthcare credentialing, enrollment, or provider operations (home infusion, specialty pharmacy, or multi-state healthcare preferred)., • Proven leadership experience managing credentialing teams in a complex, payor-driven environment., • Deep understanding of Medicare, Medicaid, and commercial payor credentialing and enrollment requirements., • Strong analytical, organizational, and cross-functional communication skills., • Demonstrated ability to lead in a fast-paced, highly regulated healthcare setting, • Percentage of Travel: 0-25% To perform this role will require frequently sitting, standing, walking, and typing on a keyboard with fingers, and occasionally bending, reaching and climbing (stairs/ladders). The physical requirements will be the ability to push/pull 1-10 lbs and lift/carry 21-30 lbs