Join our team as a Senior Manager, Credentialing, where you will provide strategic leadership and operational oversight for credentialing and provider enrollment functions across a complex healthcare environment. This work-from-home leadership role is responsible for managing credentialing operations, ensuring compliance with regulatory and accreditation requirements, and driving process improvements that support organizational goals and provider experience.
The Senior Manager, Credentialing will lead a team of approximately 30 direct reports, overseeing day-to-day credentialing activities, provider enrollment, quality assurance, performance management, staff development, and operational excellence initiatives. This role partners closely with physician leadership, practice administrators, payers, compliance teams, and other key stakeholders to ensure timely credentialing, recredentialing, and enrollment of providers while maintaining accuracy and compliance with all applicable standards.
Successful candidates will bring strong leadership experience within credentialing, provider enrollment, healthcare operations, or a related field, along with a demonstrated ability to manage large teams, implement process improvements, monitor key performance indicators, and foster a culture of accountability and continuous improvement. This is a primarily remote position with occasional travel, approximately once per month as needed, to support team engagement, operational meetings, and organizational initiatives.
Responsibilities:
- • Lead and manage the credentialing department, including staff supervision, performance evaluations, and professional development.• Oversee initial credentialing, recredentialing, and enrollment processes for physicians and advanced practice providers across multiple locations.• Ensure compliance with federal, state, and accreditation standards (e.g., JCAHO, NCQA).• Serve as the expert user of credentialing software (e.g., CredentialStream, MSOW), resolving issues and maximizing system functionality.• Develop and implement policies, procedures, and workflows to improve efficiency and data accuracy.• Coordinate with medical staff offices, enrollment teams, legal, and other stakeholders to ensure seamless credentialing operations.• Conduct audits and quality assurance checks to maintain data integrity and identify areas for improvement.• Provide training and orientation for new and existing staff on credentialing processes and systems.• Monitor productivity and ensure equitable distribution of work across the team.• Represent the credentialing department in organizational meetings and initiatives.• Maintain confidentiality of provider information and ensure secure handling of sensitive data.
- Bachelors degree required;
- Masters degree preferred.
- Minimum of 5 years of progressive experience in credentialing, with at least 2 years in a leadership role.
- CPCS or CPMSM certification preferred
- Strong knowledge of credentialing standards, healthcare regulations, and payer requirements.
- Proficiency in credentialing software and data management systems.
- Excellent communication, organizational, and interpersonal skills.
- Ability to lead teams, manage projects, and work effectively under pressure.
- Detail-oriented with a commitment to accuracy and compliance.
Licensure, Certifications, and Clearances:
- Act 34
UPMC is an Equal Opportunity Employer/Disability/Veteran
Job Details
Primary Location: USA-PA-Pittsburgh
Work Locations: Forbes Tower, 3600 Forbes Ave, 15213
Business Unit: University of Pittsburgh Physicians
Schedule: Management, Full-Time
Shift: Day Job
Union: No
Bachelor's degree required; Master's preferred. 5+ years progressive credentialing experience with 2+ years in leadership. CPCS or CPMSM certification preferred. Strong knowledge of credentialing standards and healthcare regulations.
Key Responsibilities
- managing credentialing operations
- ensuring regulatory compliance
- leading team development
Skills & Tools
CredentialStream, MSOW
Job Details
- Category: Healthcare Services - Allied Health
- Seniority: Senior Level
- Commitment: Full Time
- Workplace: Remote — Pittsburgh, Pennsylvania, United States
- Languages: English
About UPMC
A healthcare provider offering comprehensive medical services and operational support. — Industry: Healthcare