Medical Credentialing Manager - Project
Ultimate Staffing Services —Cerritos, CA
- $43.00 - $44.50 an hour
- Contract
- Bachelor's degree
- Continuous improvement
- Recruiting
Quick Apply
8d
Program Manager - Integrated Credentialing - Full Time 8 Hour Days (Exempt) (Non-Union)
USC —Los Angeles, CA
- $99,507 - $164,559 a year
- 8 hour shift
- Microsoft Outlook
- 3 years
- Master's degree
8d
Retail Operations Manager
REVOLVE —Cerritos, CA
- $100,000 - $115,000 a year
- Full-time
- 5 years
- Data analysis skills
- Mid-level
Quick Apply
Property Manager, Residential Operations
Caruso —Los Angeles, CA
- $110,000 - $140,000 a year
- Weekends as needed
- Microsoft Excel
- Microsoft Outlook
- 5 years
Credentialing Manager
Behavior Frontiers —El Segundo, CA
- $75,000 - $85,000 a year
- Full-time
- Current TB test
- Research
- Mid-level
- Paid parental leave
- Paid holidays
Quick Apply
District Operations Manager
EōS Fitness —Cerritos, CA
- $95,000 - $100,000 a year
- Full-time
- Background check
- Inventory management
- Computer literacy
- Paid holidays
- Dental insurance
Quick Apply
2026-2027 Special Education Program Manager
Ednovate —Los Angeles, CA
- $85,000 - $125,000 a year
- Full-time
- Hybrid work
- High school
- 3 years
- Senior level
- 403(b) matching
- Paid holidays
3d
Employee Assistance Program Manager
Children's Hospital Los Angeles —Los Angeles, CA
- $100,630.40 - $134,160.00 a year
- Full-time
- LMFT
- Licensed Clinical Social Worker
- Mid-level
- Employee assistance program
8d
Operations Manager
United Rentals, Inc. —Downey, CA
- $76,820 - $115,230 a year
- Full-time
- Mid-level
- 3 years
- High school diploma or GED
- Paid parental leave
- Health insurance
Regional Property Manager (LA Regional Operations)
WinnCompanies —Bellflower, CA
- $109,000 - $120,000 a year
- Full-time
- Background check
- Spanish
- Microsoft Excel
- Health savings account
- AD&D insurance
Quick Apply
Launch Operations Manager
WelbeHealth —Los Angeles, CA
- $109,240.54 - $144,197.50 a year
- Overtime
- Remote
- Clinic experience
- Mid-level
- Analysis skills
- Health insurance
- Dental insurance
Quick Apply
Operations Manager
University of California, Irvine —Irvine, CA
- $79,200 - $147,800 a year
- Full-time
- Microsoft Word
- Background check
- Microsoft Access
- Health insurance
- Retirement plan
Program Manager/Training Lead
Contact Government Services, LLC —Los Angeles, CA
- $180,000 - $200,000 a year
- Full-time
- 5 years
- Mid-level
- Supervising experience
- Health insurance
- Dental insurance
Quick Apply
Senior Credentialing Specialist - Medical Staff Admin - FT Days
University of California, Irvine —Irvine, CA
- $71,600 - $127,400 a year
- Full-time
- Background check
- Microsoft Outlook
- Customer service
- Health insurance
- Retirement plan
Billing Support Operations Manager (Remote)
Rula —Los Angeles, CA
- $116,195 - $129,865 a year
- Full-time
- Remote
- 5 years
- Experience equivalent to degree accepted
- Senior level
- Paid parental leave
- Health savings account
Director of Credentialing
Los Angeles Cancer Network —Glendale, CA
- $120,000 - $130,000 a year
- Full-time
- Customer service
- Master's degree
- Analysis skills
Quick Apply
Manager II, Escalation Operations
Pinterest —Los Angeles, CA
- $120,321 - $247,718 a year
- Remote
- 3 years
- Master's degree
- Bachelor's degree
7d
Operations Manager - Janitorial
Verde Facilities —Cerritos, CA
- $80,000 - $90,000 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Mid-level
Quick Apply
Project Manager - Integrated Credentialing - Full Time 8 Hour Days (Exempt) (Non-Union)
Keck Medical Center of USC —Los Angeles, CA
- $99,507 - $164,559 a year
- 8 hour shift
- Background check
- Microsoft Outlook
- 3 years
8d
Site Program Manager I
Think Together —Santa Ana, CA
- $70,305 a year
- Weekends as needed
- Background check
- School experience
- Spanish
Quick Apply
2d

I want to receive the latest job alert for credentialing manager in cerritos, ca

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

credentialing manager jobs near cerritos, ca

Credentialing Manager jobs in Los Angeles, CA

Credentialing Specialist jobs in Irvine, CA

Education Manager jobs in Los Angeles, CA

Program Manager jobs in Los Angeles, CA

Director jobs in Glendale, CA

Operations Manager jobs in Los Angeles, CA

Operations Manager jobs in Downey, CA

Operations Manager jobs in Irvine, CA

Property Manager jobs in Los Angeles, CA

Billing Manager jobs in Los Angeles, CA

Office Manager jobs in Rhode Island

Credentialing Manager jobs in San Antonio, TX

Case Manager jobs in Sheboygan, WI

Credentialing Specialist jobs in Maryland

Credentialing Manager jobs in Minneapolis Saint Paul, MN

Credentialing Manager jobs in Alaska

Territory Manager jobs in Raleigh, NC

Credentialing Specialist jobs in Lyndhurst, NJ

Human Resources Specialist jobs in Honolulu, HI

Credentialing Specialist jobs in Las Vegas, NV

Medical Credentialing Manager - Project

Ultimate Staffing Services -
Cerritos, CA

Quick Apply

Job Details

Contract
$43.00 - $44.50 an hour
8 days ago

Qualifications

TJC
Healthcare staff management
Database maintenance
Managed care
Managed care organization experience
Software administration
State healthcare regulations
Data summary reports
Bachelor's degree
Healthcare software applications
Healthcare data reporting

Full Job Description

Credentialing Manager

Position Summary

The Credentialing Manager is responsible for leading the Credentialing and Provider Data teams and is accountable for overseeing systems, processes, and procedures that ensure compliance with the company's credentialing policies and standards, health plan partner requirements, and all applicable regulatory and accreditation guidelines.

This role oversees the initial and ongoing credentialing and enrollment processes for all clinicians and providers. The Credentialing Manager is responsible for maintaining credentialing databases and online systems, ensuring provider files remain accurate and current, managing health plan enrollments and reappointments, and coordinating medical staff privilege applications with contracted facilities and clinics. In addition, the Credentialing Manager oversees the Provider Data function to ensure that non-contracted provider information is entered accurately and maintained in compliance with claims processing, authorization workflows, and regulatory requirements.

Responsibilities and Duties

Ensure compliance with the company's credentialing, recredentialing, and provider data management policies and procedures, as well as all applicable state, federal, accreditation, and health plan credentialing requirements.
Collaborate with organizational leadership to develop, implement, and standardize credentialing policies, procedures, and criteria across the company.
Maintain accurate, complete, and up-to-date credentialing files and records.
Ensure the integrity and accuracy of credentialing databases, reporting systems, and provider records.
Oversee the accuracy and maintenance of non-contracted provider data.
Monitor external credentialing databases and systems, including CAQH, PECOS, and other regulatory resources, ensuring provider information is current and readily accessible.
Verify that credentialing files are complete and compliant prior to presentation to the Credentialing Committee.
Provide guidance and consultation to leadership and the Credentialing Committee regarding credentialing, clinical qualifications, reappointments, and related matters.
Oversee compliance with delegated credentialing agreements, health plan requirements, and credentialing audit activities.
Manage the review and tracking of adverse actions, sanctions, licensure restrictions, disciplinary actions, and credentialing-related complaints.
Recruit, interview, hire, train, and develop credentialing staff, while providing ongoing education regarding new regulations, guidelines, and process improvements.
Monitor and manage staff workloads and credentialing workstreams, including onboarding, credentialing, pharmacy credentialing, medical staff privileging, Medicare and Medicaid enrollments, credentialing committee activities, and health plan enrollments.
Evaluate staff performance and participate in performance management activities, including coaching, corrective action, performance improvement plans, and personnel decisions when necessary.
Conduct routine audits of credentialing files, databases, and team work products to ensure compliance and quality standards are met.
Oversee initial applications and reappointments for Medicare, Medicaid, hospitals, ambulatory surgery centers, and managed care organizations.
Develop and present regular operational reports, metrics, and analyses regarding credentialing activities, including approvals, denials, appeals, and compliance performance.

Additional Responsibilities

Monitor licensure renewals, certifications, and other time-sensitive credentials, ensuring updated documentation is received, processed, and distributed to facilities and healthcare partners as required.
Coordinate and facilitate health plan meetings when needed.
Partner with leadership to identify, implement, and maintain credentialing best practices.
Serve as a primary point of contact for facilities, health plans, internal departments, and external stakeholders regarding credentialing matters.
Collaborate with leadership to maintain accurate provider rosters and ensure timely submissions to health plans and other entities.
Provide direct management and supervision of credentialing personnel and departmental operations.
Attend meetings with payer representatives to address credentialing, enrollment, and operational issues as requested.
Respond to internal and external requests regarding provider credentialing and licensing status.
Prepare reports, presentations, and analyses for leadership as requested.
Perform responsibilities in accordance with credentialing and recredentialing policies and procedures.
Perform other duties as assigned to support departmental and organizational objectives.

Education and Experience Requirements

Minimum of five (5) years of healthcare credentialing experience in a managed care environment, including at least one (1) year of supervisory or leadership experience.
Bachelor's degree in Business Administration, Healthcare Administration, or a related field required.
Strong knowledge of web-based credentialing systems and applications; experience with MD-Staff or similar credentialing software preferred.
Working knowledge of NCQA, AAAHC, The Joint Commission (TJC), AOA, URAC, and other applicable accreditation, compliance, and regulatory standards.
Demonstrated database management and reporting skills, including data analysis, querying, reporting, and document generation.
Certified Provider Credentialing Specialist (CPCS) designation preferred.
Strong organizational, analytical, communication, and leadership skills with the ability to manage multiple priorities in a fast-paced healthcare environment.

All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, and Los Angeles County Fair Chance Ordinance.

Quick Apply

Refine Your Search

credentialing manager jobs in cerritos, ca

Medical Credentialing Manager - Project

Program Manager - Integrated Credentialing - Full Time 8 Hour Days (Exempt) (Non-Union)

Retail Operations Manager

Property Manager, Residential Operations