Licensing and Credentialing Manager

• *Fully Remote**
• Salary $80-95k*

ESSENTIAL FUNCTIONS:

Reasonable Accommodations Statement:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable

Accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.
• Support the provider setup and licensing portions of the onboarding process for new clinical hires
• Manage the end-to-end process of licensing applications, ensuring completeness and accuracy of documentation for our clinicians, including nurses, social workers, therapists, and physicians.
• Track and manage state license renewals, as well as compact renewals where necessary
• Monitor and update licensing information to reflect status and changes
• Research and interpret state and federal regulations governing mental health services licensure to stay up to date with the latest regulations
• Develop and maintain a comprehensive understanding of licensing requirements across multiple jurisdictions to ensure compliance as the company expands geographically Credentialing
• Coordinate the initial credentialing and re-credentialing processes for licensed providers , including reviewing and verifying education, training, licensure, and professional experience to ensure adherence to organizational standards and regulatory requirements.
• Track and manage all provider credentialing as we add new payor contracts and expand to new states.
• Monitor and update credentialing information to reflect status and changes
• Maintain a comprehensive database of provider credentials, ensuring accuracy and compliance with organizational policies and relevant regulations
• Support Payor enrollment activities where required to ensure providers are properly set up in Payor systems Documentation and Compliance
• Maintain accurate and up-to-date records of all licensing, credentialing, and privileging activities, including documentation of compliance with regulatory standard
• Conduct regular audits and reviews of licensing and credentialing records to identify discrepancies, gaps, or potential areas of non-compliance
• Provides support for interpretation, development, and implementation of all systems and functions to ensure continuous compliance with state and federal law, organization policies, regulatory agencies and accrediting body standards Cross-functional Collaboration
• Collaborate closely with internal stakeholders, including clinical operations, legal, human resources, and finance teams, to ensure alignment of licensing and credentialing activities with organizational goals and objectives
• Serve as a subject matter expert on licensing and credentialing matters, providing guidance and support to internal teams as needed Delegated Credentialing
• Lead the oversight of all delegated activities to ensure compliance with CMS, and NCQA requirements.
• Responsible for ensuring thorough preparation of documentation, reports and any other information needed for regulatory and NCQA audits related to delegation oversight.
• Coordinate communication with delegates regarding regulatory and NCQA audits.
• Implement and maintain a comprehensive delegation oversight program which supports all aspects of credentialing delegation
• Monitor delegates and internal business owner relationships to ensure compliance and optimal delegate performance and achievement of business goals according to service level and other contractual requirements.
• Responsible for the management of delegation performance, including monthly, quarterly, annual performance reporting and Corrective Action Plans (CAP)
• Direct pre-delegation audits, annual audits, required reporting and ongoing oversight of delegates.
• Lead the development and maintenance of delegated related policies and procedures.
• Initiate implementation of new or changed regulatory and/or accreditation requirements to ensure the adequacy of controls of oversight activities.
• Chair the Delegation Oversight Committee and taking appropriate committee minutes
• Collaborates with payor, compliance, and RCM leaders in support of an ongoing performance improvement and reporting process that is accurate, timely and action driven.
• Provides ongoing communication with leaders especially in regards to risk/issues identified during the credentialing/recredentialing process for delegated credentialing.
• Contributes and supports technology integration and migration with other system information systems
• Supports completion of regulatory and accreditation surveys.
• Supports education, professionalism, practice-based learning and systems-based learning
• Provides initial orientation and ongoing education to designated team members on delegated credentialing processes, software, self-audits, and other education as needed

SKILLS & ABILITY:

Education: Bachelor’s Degree in related fields with a minimum of 4 years’ experience required

Experience: 3-5+ years administrative experience in healthcare setting is preferable
• Experience with licensing or credentialing (with varying provider types) required; specific experience with therapists, nurses, nurse practitioners, and medical doctors preferred
• Thorough knowledge of state and federal regulations related to mental health licensure, credentialing, and privileging requirements
• Very strong attention to detail and outstanding organization skills
• Excellent task management and communication skills, ability to work successfully across diverse teams

Computer Skills: Proficient in Microsoft Office (Excel, PowerPoint, Word, SharePoint); comfort and familiarity with provider licensure and credentialing software (e.g. Medallion) a plus.

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