Credentialing Program Lead

Modern Health

5d•$91,163 - $143,000•Remote

About The Position

Modern Health is looking for a Credentialing Program Lead to lead and optimize our credentialing program for a growing provider network. This is an individual contributor role to start. You will serve as the primary owner of credentialing program execution and continuous improvement, strengthening the policies, workflows, recredentialing standards, audit readiness, reporting, and governance already in place to support a scalable, compliant provider network. This is a high-impact role for someone who is equal parts program lead, operator, and subject matter expert. You are comfortable improving existing processes, identifying gaps and opportunities, and translating regulatory requirements into practical, scalable workflows while driving cross-functional execution without direct people management.

Requirements

5+ years of experience leading and optimizing credentialing programs, provider operations, provider enrollment, licensing, or a related healthcare operations function
Experience administering Credentialing Committee activities, provider governance processes, audits, and regulatory reviews.
Knowledge of credentialing and recredentialing standards, including NCQA, URAC, state regulatory requirements, and delegated credentialing arrangements.
Experience improving credentialing infrastructure, policies, workflows, controls, or operating models in a growing environment
Experience with credentialing software, provider data management systems, primary source verification tools, CAQH, NPDB, provider lifecycle management platforms and credentialing documentation requirements.
Experience supporting audits, accreditation readiness, delegated credentialing oversight, or similar compliance programs
Strong program management, analytical, and cross-functional communication skills
Comfortable balancing strategic process improvement with hands-on operational execution.
Applicants must be able to maintain work authorization for the duration of employment without employer sponsorship or employer-provided training plans or attestations (including, for example, the Form I-983 required for STEM OPT). Immigration sponsorship is not available for this position.

Nice To Haves

Experience in digital health, telehealth, behavioral health, or a multi-state provider network environment
Experience with credentialing platforms, provider data systems, or vendor oversight
Certified Provider Credentialing Specialist (CPCS), Certified Professional Medical Services Management (CPMSM), or equivalent credentialing certification preferred.

Responsibilities

Lead and optimize Modern Health’s credentialing program, including initial credentialing, recredentialing, ongoing monitoring, exception handling, and documentation standards
Lead the administration and operations of the Credentialing Committee, including agenda development, case preparation, primary source verification review, documentation management, meeting facilitation, decision tracking, and follow-up activities.
Ensure credentialing and recredentialing activities are conducted in accordance with organizational policies, accreditation standards, regulatory requirements, and the enterprise quality governance structure.
Improve and scale policies, SOPs, controls, and governance processes aligned with regulatory and accreditation requirements
Define and refine program goals, SLAs, metrics, and reporting to monitor timeliness, quality, audit readiness, and operational performance
Streamline workflows for licensure, sanctions, exclusions, malpractice, expirables, renewals, and issue resolution
Serve as a key liaison across Provider Operations, Clinical Quality, Compliance, Legal, and Recruiting/Onboarding to strengthen provider credentialing oversight, mitigate organizational risk, support audit readiness, and drive accountability to Quality Committee priorities.
Identify process, tooling, and vendor opportunities that improve scalability, visibility, and provider experience
Serve as the credentialing SME for audits, escalations, governance reviews, and credentialing-related provider status decisions
Support day-to-day credentialing operations while driving a more scalable future-state model

Benefits

Medical / Dental / Vision / Disability / Life Insurance
High Deductible Health Plan with Health Savings Account (HSA) option
Flexible Spending Account (FSA)
Access to coaches and therapists through Modern Health's platform
Generous Time Off
Company-wide Collective Pause Days
Parental Leave Policy
Family Forming Benefit through Carrot
Family Assistance Benefit through UrbanSitter
Professional Development Stipend
401k
Financial Planning Benefit through Origin
Annual Wellness Stipend to use on items that promote your overall well being
New Hire Stipend to help cover work-from-home setup costs
ModSquad Community: Virtual events like active ERGs, holiday themed activities, team-building events and more
Monthly Cell Phone Reimbursement