Senior Manager, Credentialing Operations

CVS Health•Hartford, CT

About The Position

The Senior Manager, Credentialing Operations leads critical functions within the Credentialing Verification Organization (CVO) and is accountable for delivering credentialing services, including production, quality, reporting, ongoing monitoring, and continuous process improvement. The role ensures the accuracy, integrity, and compliance of provider credentialing data across multiple lines of business, supporting the development and maintenance of a high-quality provider network. The Senior Manager advances health plan objectives by driving operational excellence, regulatory compliance, quality outcomes, and provider experience. In collaboration with cross-functional partners, the role uses data-driven insights, process optimization, and strategic execution to improve credentialing performance, service delivery, and timely, accurate credentialing decisions that support member access to care.

Requirements

Minimum of 5 years of experience in provider data management, provider network operations, provider relations, credentialing, or a related healthcare operations function.
Minimum of 3 years of experience leading and developing teams.
Experience working in credentialing operations.
Knowledge of and experience supporting Medicare, Medicaid, and/or Commercial Health Insurance lines of business.
Strong analytical, problem-solving, and decision-making skills.
Demonstrated ability to influence stakeholders and drive results across cross-functional teams.
Strong written and verbal communication skills.
Bachelor's degree or equivalent work experience.

Nice To Haves

Experience leading operational transformation or continuous improvement initiatives.
Experience working within a Credentialing Verification Organization (CVO) environment.
Experience utilizing data and metrics to drive operational performance and business decisions.
Proven ability to manage multiple priorities in a fast-paced, highly regulated environment.

Responsibilities

Lead a business services unit that delivers credentialing services in support of organizational objectives.
Establish and communicate strategic direction for Credentialing Operations and align processes with enterprise goals and priorities.
Analyze operational performance metrics and key initiatives to evaluate progress against business objectives and identify improvement opportunities.
Develop and implement strategies to enhance operational effectiveness, quality, compliance, and service delivery.
Serve as a trusted advisor to internal and external stakeholders on credentialing operations, business reviews, and related initiatives.
Lead audit activities, including issue identification, corrective action planning, error remediation, and rebuttal management.
Review audit findings for accuracy and guide issues with significant business or regulatory implications.
Partner with Network Management, Provider Relations, Provider Services, Health Delivery teams, and other cross-functional stakeholders to address provider-related issues and improve operational outcomes.
Drive continuous improvement initiatives that streamline processes, reduce risk, and enhance provider and customer experience.
Foster a culture of accountability, collaboration, innovation, and high performance.