Credentialing Operations Manager

Paradigm • Tampa, FL

1d • Hybrid

About The Position

Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex injuries and diagnoses. The company has been a pioneer in value-based care since 1991 and has an exceptional track record of generating the very best outcomes for patients, payers, and providers. Deep clinical expertise is the foundation for every part of Paradigm’s business: risk-based clinical solutions, case management, specialty networks, home health, shared decision support, and payment integrity programs.
We’re proud to be recognized—again! For the fourth year in a row, we’ve been certified by Great Place to Work®, and for the third consecutive year, we’ve earned a spot on Fortune's Best Workplaces in Health Care™ list. These honors reflect our unwavering commitment to fostering a positive, inclusive, and employee-centric culture where people thrive.
Watch this short video for a brief introduction to Paradigm.
Paradigm Specialty Networks is seeking an experienced Credentialing Operations Manager to lead and continuously improve our clinician and facility credentialing and recredentialing programs. This full-time, exempt role is responsible for ensuring compliance with regulatory and accreditation standards while driving efficient, accurate, and timely credentialing operations across the organization.
Reporting to the VP of Strategic Initiatives & Execution, the Credentialing Operations Manager partners closely with internal teams, providers, facilities, and delegated entities to support audit readiness, policy development, and process improvement initiatives. This position plays a critical role in maintaining high-quality standards and supporting enterprise-wide operational excellence.
This is a full-time hybrid position, with an expectation to report to the Tampa office as needed.

Requirements

• Bachelor’s degree in healthcare administration, business, or a related field (Master’s preferred).
• Minimum of 3–5 years of experience in credentialing operations, with at least 2 years in a leadership or management role.
• Thorough understanding of credentialing requirements, accreditation standards, and regulatory guidelines (e.g., NCQA, URAC, CMS, The Joint Commission).
• Proficiency in Microsoft Office suite (Excel, PowerPoint, Word), data visualization tools (e.g. Power BI).
• Strong ability to analyze complex data sets and derive actionable insights.
• Exceptional written and verbal communication skills, with the ability to simplify complex topics for diverse audiences.
• Proven ability to work collaboratively with cross-functional teams in a fast-paced environment.
• Strong focus on accuracy and thoroughness in all deliverables.

Nice To Haves

• Experience with credentialing software and data management systems.

Responsibilities

• Oversee and manage the initial credentialing process for all clinicians (physicians, advanced practice providers, allied health professionals) and healthcare facilities.
• Ensure all applications and supporting documentation are collected, verified, and maintained according to organizational policies and regulatory requirements.
• Coordinate and communicate with providers, facilities, and internal teams to resolve discrepancies and expedite credentialing timelines.
• Lead and manage periodic recredentialing of clinicians and facilities in compliance with organizational, state, and federal guidelines.
• Monitor upcoming recredentialing deadlines and proactively communicate with providers and facilities to ensure timely completion.
• Analyze data and develop process improvements to streamline recredentialing activities and enhance compliance.
• Develop and implement audit tools and protocols to assess delegated entities' compliance with credentialing standards.
• Conduct regular delegation audits, document findings, and report results to leadership and relevant stakeholders.
• Provide guidance and corrective action plans for delegated entities not meeting performance or compliance expectations.
• Maintain and update credentialing and recredentialing policies to reflect current regulations and best practices.
• Train and support credentialing staff on policies, procedures, and regulatory changes.
• Ensure all credentialing activities align with NCQA, URAC, The Joint Commission, and other relevant accreditation standards.
• Prepare for and participate in internal and external audits and surveys.
• Act as a primary point of contact for credentialing inquiries from providers, facilities, internal departments, and regulatory agencies.
• Provide regular updates and reports on credentialing status, compliance metrics, and audit outcomes to senior leaders.
• Responsible for complying with Paradigm Information Security requirements and policies, for safeguarding Paradigm or Paradigm related passwords, and for notifying Paradigm of any Information Security incidents per policy SEC 10-12 Information Security Incident Management.
• Mentor, train, and supervise team members directly and indirectly, review their work and provide effective constructive feedback to achieve their best performance and goal attainment
• Set the tone for a strong Enterprise culture and high employee engagement.
• Ensure all team members understand, are trained in, and comply with Paradigm’s security requirements and policies.
• Ensure all team members have the minimum level of IT system access required to effectively complete their Paradigm responsibilities.

Benefits

• Health and wellness– We want our people to be and stay healthy, so we offer PPO, HDHP, and HMO health insurance options with Cigna and Kaiser (CA employees only).
• Financial incentives – Paradigm’s financial benefits help prepare you for the future: competitive salaries, 401(k) matching contributions, employer-paid life and disability insurance, flexible spending and commuter accounts, and employer-matched HSA contributions.
• Vacation - We believe strongly that work-life balance is good for you and for our company. Our paid time off and personal holiday programs give you the flexibility you need to live your life to the fullest.
• Volunteer time– We want our employees to engage with and give back to their communities in meaningful ways. Full and part-time employees receive one paid day per calendar year.
• Learning and development: One of Paradigm’s core values is expertise, so we encourage our employees to continually learn and grow. We support this in a variety of ways, including our new Learning Excellence at Paradigm (LEAP) program.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager