Credentialing & Licensing Manager

Zivian Health

27d•Remote

About The Position

This role is for a credentialing expert who thinks strategically and executes with precision. The ideal candidate understands the complexities of NCQA credentialing and payor enrollment and is excited to redesign and elevate credentialing processes at a fast-growing healthtech company. The role thrives at the intersection of operations, technology, and compliance, focusing on building scalable systems. The position requires cross-functional collaboration with Product and Operations teams, as well as leadership and development of a team.

Requirements

5+ years of experience in credentialing, medical staff services, or provider enrollment, with at least 2 years in a management or team lead role.
Deep, hands-on knowledge of NCQA credentialing standards and payor credentialing/enrollment processes.
Proven ability to lead, develop, and hold accountable a team of credentialing professionals.
A builder’s mindset: you’re not just here to maintain the status quo, but to redesign and improve how credentialing works.
Strong cross-functional collaboration skills—you can work effectively with Product, Operations, and external stakeholders alike.
Excellent organizational skills and ruthless attention to detail; you don’t let things fall through the cracks.
Comfort with technology and credentialing systems; ability to quickly learn and adapt to new platforms.
Strong written and verbal communication skills—you can translate complex regulatory requirements into clear, actionable guidance.
Ability to balance strategic thinking with hands-on execution in a fast-paced, startup environment.

Nice To Haves

Bachelor’s degree in Healthcare Administration, Business, or a related field preferred
CPCS or CPMSM certification a plus

Responsibilities

Own the vision and roadmap for credentialing and licensing at Zivian, transforming the function from transactional to a strategic driver of provider success and organizational growth.
Redesign and rebuild credentialing workflows end-to-end—identifying gaps, eliminating bottlenecks, and implementing scalable, best-in-class processes.
Serve as Zivian’s internal subject matter expert on NCQA credentialing standards, payor enrollment requirements, and state licensing regulations.
Partner closely with Product to shape and inform the credentialing and licensing features of Zivian’s software platform, translating operational needs into product requirements.
Collaborate with the broader Operations team to ensure credentialing workflows integrate seamlessly with provider onboarding, engagement, and compliance processes.
Oversee end-to-end credentialing processes for providers, including initial credentialing, re-credentialing, and payor enrollment.
Ensure compliance with NCQA guidelines, CMS requirements, state licensing regulations, and payor-specific credentialing standards.
Manage and monitor expirable tracking for licenses, certifications, and accreditations—ensuring proactive renewals with no lapses.
Maintain accurate, complete, and audit-ready credentialing files in compliance with HIPAA and applicable privacy regulations.
Lead, manage, and develop a team of Licensing Specialists, fostering a high-performance culture rooted in quality, accountability, and continuous improvement.
Build and maintain SOPs and process documentation to standardize credentialing operations across the team.
Leverage credentialing systems and databases to ensure data integrity and generate reports for leadership and external stakeholders.
Identify systemic process gaps and implement documented improvements to accelerate speed and reduce error rates.