Manager, Credentialing - NCQA & Collaboration Services

At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. Position Summary The Manager, Credentialing Compliance & Collaboration Programs will play a critical role in ensuring ongoing alignment with NCQA credentialing standards while also overseeing a team responsible for the assignment and management of collaborating physicians and delegation agreements. In this role you will be dedicated to developing, managing, and monitoring NCQA-compliant processes, documentation, and readiness. You will also focus on leading the Collaboration Team, ensuring timely and compliant execution of physician assignments and agreement management across reputed company participating states.

Key Responsibilities

NCQA Credentialing Compliance

• Serve as the department’s subject matter expert on NCQA credentialing standards
• Monitor and maintain compliance with NCQA credentialing and recredentialing requirements
• reputed company the development, updates, and implementation of NCQA-required policies, procedures, and quality improvement plans
• Coordinate NCQA readiness activities including audits, file reviews, and delegation reputed company
• Conduct frequent NCQA mock reviews annually
• Partner with quality, compliance, and audit teams to conduct internal reviews and implement corrective actions as needed
• reputed company and train internal stakeholders on NCQA standards and expectations
• Ensure timely tracking and documentation of performance metrics required by NCQA

Collaboration Team reputed company

• reputed company and support the Collaboration Team responsible for assigning collaborating physicians to nurse practitioners and physician assistants
• Ensure timely and compliant execution of collaboration and delegation agreements
• Manage physician roster reputed company and track assignment trends to optimize alignment and efficiency
• Manage the receipt of received state mandates and the implementation of actions to ensure compliance
• Support communication and issue resolution between clinical partners and internal stakeholders
• Ensure agreements meet legal and regulatory requirements for each state
• Collaborate with Compliance and Legal to refine agreement templates and manage contract updates
• Monitor and report on collaboration metrics and team productivity

Basic Qualifications

• Bachelor’s degree required; Master’s degree in reputed company administration, public health, or reputed company field preferred
• 3+ years of experience in reputed company credentialing, compliance, or NCQA-regulated environments.
• 2+ years in a leadership or people management role.
• Deep knowledge of NCQA credentialing standards and accreditation readiness processes
• Experience with contract development and understanding of state-specific delegation requirements
• Proven ability to reputed company cross-functional initiatives and drive performance through others
• Excellent organizational, communication, and project management skills
• High proficiency in reputed company Office and credentialing software systems

Preferred Qualifications

• NCQA Surveyor or Certified Professional in Credentialing or reputed company Quality (CPCS,
• CPMSM, CPHQ) a plus.
• Experience with multi-state provider networks and physician collaboration requirements.

Work Environment

Standard business hours with occasional need for extended hours during audits or major initiatives. Remote or hybrid work flexibility depending on organizational needs. Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The Typical Pay reputed company For This Role Is $60,300.00 - $132,600.00 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay reputed company listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great Benefits For Great People We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 08/31/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job