SUMMARY
The Credentialing Operations Manager is responsible for overseeing and optimizing key credentialing, licensing and privileging operational processes and the systems that enable them. This role drives efficiency, scalability, and continuous improvement by aligning operations and business processes with technology solutions. In addition, the manager will carry credentialing responsibilities as assigned by the Director and partner across the department’s functions to enhance performance, ensure compliance, and deliver an optimized physician credentialing experience.
General Hours of Work: Monday - Friday (Days)
Exempt/Nonexempt: Exempt (Salaried)
Department/Unit: Corporate - Clinical
Reports To: Director, Medical Staff Services
ESSENTIAL FUNCTIONS
1. Process Management & Optimization
- Designs, documents, and implements standardized workflows and procedures
- Manages the designed processes to ensure optimal performance across the department
- Identifies inefficiencies and lead process improvement initiatives (Lean, Six Sigma, automation)
- Establishes and tracks KPIs (cycle time, quality, throughput, cost)
- Ensures processes are scalable, compliant, and aligned with business goals
2. Tools & Systems Management
- Serves as primary business owner for operational systems and tools (MD Staff)
- Oversees system configuration, workflows, and enhancements
- Partners with IT and vendors on upgrades, integrations, and issue resolution
- Ensures system reliability, user adoption, and data integrity
- Reports and analyses: Generate detailed reports highlighting discrepancies, access patterns, and areas for improvement
- Continuous monitoring and evaluation: regularly audit database activities and to detect anomalies, unauthorized access, or suspicious behavior
- Manages user access, roles, and system governance
3. Cross-Functional Collaboration
- Acts as a liaison between business stakeholders, IT, and operations
- Translates business requirements into process and system solutions
- Supports training, communication, and adoption of new tools/processes
- Aligns priorities across departments to drive outcomes
4. Ownership & Accountability
- Serves as the primary business owner for the system and its data
- Defines system purpose, scope, and business requirements
- Ensures the system supports operational and strategic objectives
- Optimizes organizational and business unit utilization
- Supervises a small team of Licensing & Credentialing Specialists
5. Governance & Compliance
- Ensures compliance with organizational policies, security standards, and regulatory requirements
- Approves system access, roles, and permissions
- Participates in audits, risk assessments, and compliance reviews
- Ensures proper data classification and handling
6. Operational Oversight
- Monitors system performance, availability, and user satisfaction
- Escalate issues impacting business operations
7. Credentialing and Privileging Responsibilities
- Processes applications as required to support team workload demands.
- Performs primary source verification activities as needed to meet team workload requirements.
- Coordinates mail operations, preparing and sending documents via FedEx for provider review and completion, and maintaining efficient workflow processes.
ESSENTIAL QUALIFICATIONS: The individual must be able to work the hours specified above. To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed above are representative of the knowledge, skills, and/or abilities required to perform the essential functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions, so long as the accommodations do not cause undue hardship to the employer.
EDUCATION and/or EXPERIENCE
- Bachelor’s degree in healthcare, Business Administration, Information Technology, or a related field required.
- 7+ years of experience in Operations, process improvement, or transformation along with systems and tools ownership required.
- Experience with credentialing software deployment in a hospital or telemedicine environment.
- Strong understanding of business processes supported by the system and knowledge of information security, risk management, and data governance principles is preferred.
ABOUT AVEL eCARE
Avel eCare is a nationally recognized telemedicine care provider offering the largest and most comprehensive virtual health networks in the world. Based in Sioux Falls, South Dakota, Avel operates a multispecialty telemedicine network, partnering with more than 650 health care systems, rural hospitals, outpatient clinics, long-term care facilities, school districts, prisons, skilled nursing facilities and law enforcement agencies to deliver innovative telemedicine care across the country.
During the past three decades, Avel has developed eight distinct telehealth services, —Behavioral Health, Critical Care, Emergency, Hospitalist, Pharmacy, Specialty Care, Senior Care and School Health—in response to needs expressed by the communities and clinicians whom Avel serves. Within the past year alone, Avel’s virtual health care delivery model has impacted the lives of nearly two million patients. The efficiency of these telehealth services have saved health care costs and unnecessary time and travel for patients and physicians. On a national and world level, we are a model of how telehealth presents effective solutions today and tomorrow’s most daunting challenges.
An innovative spirit among Avel eCare employees provided the spark that started Avel eCare’s telemedicine movement and is what continues to fuel our ability to transform the way healthcare is delivered across the world today. When you join the Avel team, you’ll appreciate the dedication, collaboration and support of other highly skilled professionals who work with you onsite in our virtual hospital hub or through our remote workforce.
MISSION
Every person and every community deserves access to high quality care. Avel’s experts collaborate with local clinicians through telemedicine, to deliver high quality care when and where it’s needed.
VISION
Avel eCare serves as a catalyst for change. We are creating a future of health care without boundaries through Service, Quality, Collaboration, and Innovation.
