Credentialing Manager

Curana Health, Inc.•Remote,

About The Position

At Curana Health, we're on a mission to radically improve the health, happiness, and dignity of older adults—and we're looking for passionate people to help us do it. As a national leader in value-based care, we offer senior living communities and skilled nursing facilities a wide range of solutions (including on-site primary care services, Accountable Care Organizations, and Medicare Advantage Special Needs Plans) proven to enhance health outcomes, streamline operations, and create new financial opportunities. Founded in 2021, we've grown quickly—now serving 200,000+ seniors in 1,500+ communities across 32 states. Our team includes more than 1,000 clinicians alongside care coordinators, analysts, operators, and professionals from all backgrounds, all working together to deliver high-quality, proactive solutions for senior living operators and those they care for. Ranked #147 on the Inc. 5000 list of America's fastest-growing private companies, we're just getting started. If you're looking to make a meaningful impact on the senior healthcare landscape, you're in the right place—and we look forward to working with you. For more information about our company, visit CuranaHealth.com. Summary We are seeking an experienced Credentialing Manager to lead our Professional Credentialing team and oversee the end-to-end practitioner credentialing and recredentialing process. This role is critical to maintaining regulatory compliance, supporting provider network growth, and ensuring credentialing operations are completed accurately and efficiently. The ideal candidate brings substantial experience within a managed care organization or large health plan, along with a strong background in provider credentialing, team leadership, reporting, inventory management, and process improvement. This individual will combine strategic thinking with hands-on operational leadership to strengthen workflows, improve visibility into credentialing activity, and support expansion into new markets.

Requirements

Bachelor’s degree or an equivalent combination of education and relevant healthcare experience.
Minimum of 7 years of experience in a managed care organization or large health plan environment.
Minimum of 5 years of direct provider credentialing and contracting experience.
Demonstrated experience leading provider credentialing operations and managing team performance.
Strong knowledge of physician credentialing standards and requirements established by CMS, NCQA, state agencies, and Medicaid programs.
Experience using CredentialStream or a comparable credentialing platform.
Proficiency with Excel and SharePoint.
Proven experience managing high-volume credentialing workflows, provider file inventory, quality metrics, and operational deadlines.
Experience building, improving, or repairing credentialing processes and tracking systems.
Strong reporting and analytical skills, including the ability to track and interpret credentialing trends and performance.
Excellent written and verbal communication skills, with the ability to work effectively across organizational levels and with external partners.
Proficiency with Microsoft Office applications and credentialing management systems.

Nice To Haves

Experience working for a national or regional managed care organization or large health plan.
Experience performing SQL-related processes or working with SQL-supported reporting.
Interest in using AI, automation, bots, or agents to improve operational efficiency.
Demonstrated success implementing process improvements in a complex, high-volume credentialing environment.

Responsibilities

Lead and oversee the full practitioner credentialing and recredentialing process in alignment with CMS, NCQA, state, Medicaid, and insurance requirements.
Manage and support a team of credentialing professionals responsible for professional provider credentialing.
Monitor provider file inventory, team workflows, production benchmarks, quality assurance, and credentialing turnaround times.
Establish clear tracking and reporting processes to provide leadership with visibility into provider status, team performance, credentialing volume, and potential risks.
Develop, implement, and maintain credentialing policies and procedures.
Identify inefficiencies and lead process-improvement initiatives that increase consistency, quality, accuracy, and operational efficiency.
Maintain accurate provider status information within the organization’s provider data management and credentialing systems.
Oversee credentialing correspondence, including approvals, denials, requests for information, and provider follow-up.
Partner with data management and IT teams to support credentialing system integration and operational improvements.
Research and resolve credentialing issues while implementing solutions that help prevent recurrence.
Maintain documentation for the Credentialing Committee, manage meeting agendas, and present credentialing recommendations.
Ensure timely communication with providers and internal stakeholders regarding credentialing status changes.
Oversee provider outreach, application submission, documentation, and internal quality-assurance processes.
Train and support team members, Medical Directors, and health plan partners on credentialing processes and tools.