Provider Qualifications Supervisor - RN

CenCal Health • Santa Barbara, CA

2d • $107,000 - $160,000 • Onsite

About The Position

The Provider Qualifications Supervisor is responsible for the operational leadership, regulatory compliance, and continuous improvement of CenCal Health’s provider credentialing, privileging, and enrollment processes. This position combines the hands-on technical expertise of credentialing activities with people leadership, audit readiness, delegation management, and cross-functional collaboration to ensure full compliance with NCQA, DHCS, CMS, and other applicable regulatory and accreditation standards. This position serves as a key escalation point for complex provider qualification issues, delegated credentialing relationships, sanctions, and adverse actions, while also driving strategic initiatives to improve timeliness, accuracy, cost-effectiveness, and data integrity across credentialing and provider data programs. The Supervisor plays a critical role in survey readiness, performance management, and the development of scalable, compliant processes that support organizational growth and value-based care. This position works under the supervision of the Provider Credentialing and Data Integrity Manager. Provides day-to-day operational oversight and escalation management for credentialing and provider qualification functions, ensuring timely, accurate, and compliant execution aligned with organizational priorities and regulatory standards. Ensures end-to-end oversight of credentialing, recredentialing, privileging, and enrollment processes, with accountability for eligibility determinations, documentation quality, and regulatory compliance. Leads delegated credentialing oversight and audit readiness by managing agreements, monitoring performance, and coordinating corrective actions to maintain compliance with contractual and regulatory requirements. Drives continuous improvement initiatives to enhance efficiency, reduce risk, and strengthen compliance across credentialing and provider qualification workflows using data-driven analysis. Oversees the integrity, accuracy, and governance of provider credentialing data across systems, ensuring reliable reporting, effective controls, and timely resolution of discrepancies. Builds and sustains a high-performing team through effective supervision, professional development, and stakeholder collaboration, while serving as a trusted subject matter expert and leader. Other duties as assigned.

Requirements

• Proven leadership skills including motivating staff and performance management.
• Able to multi-task in a fast-paced environment, managing multiple priorities and meeting deadlines.
• Strong time management and organizational skills.
• Able to use good judgment in making decisions within scope of authority and handle sensitive issues with tact and diplomacy.
• Able to process a high volume of work and assume special projects over and above assigned responsibilities.
• Strong leadership, organizational, and communication skills.
• Ability to manage multiple priorities, meet deadlines, and ensure compliance with regulatory requirements.
• Excellent problem-solving skills for resolving complex credentialing and site review issues.
• Proficiency in Microsoft Office, virtual platforms, credentialing software.
• Bachelor’s degree in Business Administration, Health Care Administration, Public Health, or a related field.
• Three (3) years of experience in provider credentialing, accreditation, regulation, licensing, healthcare quality, or a closely related field.
• Minimum of two (2) years of experience in a supervisory or leadership role.
• An equivalent combination of education, training, and relevant experience may be considered.

Nice To Haves

• Experience with credentialing and familiarity with NCQA, DHCS and CMS and other regulatory standards related to credentialing and provider quality management processes. preferred.
• Familiarity with credentialing software systems, as well as Microsoft Office Suite preferred.
• CPCS strongly desired OR achievement of certification within 24 months.

Responsibilities

• Provides day-to-day operational oversight and escalation management for credentialing and provider qualification functions, ensuring timely, accurate, and compliant execution aligned with organizational priorities and regulatory standards.
• Ensures end-to-end oversight of credentialing, recredentialing, privileging, and enrollment processes, with accountability for eligibility determinations, documentation quality, and regulatory compliance.
• Leads delegated credentialing oversight and audit readiness by managing agreements, monitoring performance, and coordinating corrective actions to maintain compliance with contractual and regulatory requirements.
• Drives continuous improvement initiatives to enhance efficiency, reduce risk, and strengthen compliance across credentialing and provider qualification workflows using data-driven analysis.
• Oversees the integrity, accuracy, and governance of provider credentialing data across systems, ensuring reliable reporting, effective controls, and timely resolution of discrepancies.
• Builds and sustains a high-performing team through effective supervision, professional development, and stakeholder collaboration, while serving as a trusted subject matter expert and leader.
• Other duties as assigned

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 101-250 employees