Über diese Senior Manager, Credentialing Stelle bei Altais
About Altais:
At Altais, we’re on a mission to improve the healthcare experience for everyone—starting with the people who deliver it. We believe physicians should spend more time with patients and less time on administrative tasks. Through smarter technology, purpose-built tools, and a team-based model of care, we help doctors do what they do best: care for people.
Altais includes a network of physician-led organizations across California, including Brown & Toland Physicians, Altais Medical Group Riverside, and Family Care Specialists. Together, we’re building a stronger, more connected healthcare system.
About the Role
Are you looking to join a fast-growing, dynamic team?
We’re a collaborative, purpose-driven group that’s passionate about transforming healthcare from the inside out. At Altais, we support one another, adapt quickly, and work with integrity as we build a better experience for physicians and their patients.
This role is responsible for the strategic direction and operational oversight of the credentialing function to support, develop, manage and monitor processes and procedures for the credentialing, re-credentialing, expirables data management and delegated functions for all our Health Plan Partners for all lines of business. This role manages the credentialing program for Altais affiliated entities, including employed clinicians, vendors providing clinical services on the MSOs behalf, as well as MSO services for any other medical group or IPA purchasing from Altais Health Solution including application management and primary source verification completion. This role is also responsible for the administrative aspects for all credentialing functions needed to meet medical group, health plan and accrediting body requirements including but not limited to the National Committee for Quality Assurance (NCQA), the Centers for Medicare & Medicaid Services (CMS), and the Department of Managed Health Care (DMHC). This role, in combination with the Credentialing team, is to maintain procedures, processes and internal & vendor systems in line with all regulation and compliance requirements. This role has key vendor management oversight responsibilities to ensure our contracted vendor systems and services are delivering services and capabilities as expected. Additionally, this role will oversee the interdependencies between departments, consistently maintaining knowledge and understanding of the impact to providers and how that may affect overall business operations and financial outcomes. At the senior level, this role owns the credentialing policy portfolio, the development and maintenance of departmental training documentation, preparation and facilitation of the Credentialing Committee, pre-delegation and ongoing oversight audits of sub-delegated entities, and the development of key performance indicators and executive reporting for the function.
You will focus on:
Providing leadership / coaching to the credentialing team staff, ensuring function initiatives and deliverables are complete and accurate in a timely manner
Responsible for processing credentialing applications accurately and promptly in accordance with Credentialing policies and procedures and in full compliance with all regulations with a continued focus on delivery of a high-quality product with the greatest level of efficiency
Manages audit preparation of materials and files necessary to comply with external audits by payors and/or governmental agencies
Manages relationships with health plan delegation oversight teams.
Manages peer review physician documentation for Clinical Advisory Group
Develops, maintains, and annually reviews credentialing training documents, desktop procedures, and onboarding materials for the credentialing team
Conduct audits of the credentialing database, confirming accurate input of provider data, and verifying accuracy of modifications made to the database and downstream impacts to other reporting tools and functions
Owns Credentialing Database system modifications and workflows development and implementation
Manages vendor systems and services performance
Leads credentialing committee effectiveness in partnership with the Chief Medical Officer. Prepares and facilitates the Credentialing Committee, including agenda development, file preparation and presentation, meeting minutes, and follow-through on committee determinations
Conducts pre-delegation and annual oversight audits of sub-delegated entities, evaluates compliance against NCQA, CMS, and DMHC requirements, issues corrective action plans, and monitors remediation to closure
Owns the credentialing policy portfolio, including annual review, revision, and approval routing of policies and procedures to maintain alignment with regulatory and accreditation standards
Develops key performance indicators for the credentialing function and creates recurring dashboards and ad hoc reporting for executive leadership
Develops functional, market level, and/or site strategy, plans, production and/or organizational priorities for Altais Health affiliated groups as well as clients purchasing MSO services.
Identifies and resolves technical, operational and organization problems outside own team
Other duties as assigned
The Skills, Experience & Education You Bring
Bachelor’s degree or equivalent to 4 year university degree, preferably in healthcare related field of study.
10+ years professional experience working in credentialing, preferably in a managed care setting required.
2+ years of employee / team management experience.
Requires advanced knowledge of credentialing software and CRM tools plus expert working knowledge of NCQA, CMS Conditions of Participation, Medicare Advantage requirements, and DMHC regulations, including delegation oversight and audit readiness.
Required Certifications
Must be eligible to take National Association Medical Staff Services (NAMSS), Certified Provider Credentialing Specialist exam within 18 months of employment
NAMSS Credentialing certification preferred.
The Base Salary for this position is $89,250 – 107,100/year
In addition, we provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.
Excellent medical, vision, and dental coverage
401k savings plan with a company match
Flexible time off and 9 Paid Holidays
You Share Our Mission & Values:
Compassion
We act with empathy and a deep respect for the challenges faced by physicians and their patients. Our work is driven by a genuine commitment to improving lives and ensuring that care is delivered with dignity, understanding, and humanity.
Community
We foster a culture of collaboration--with physicians, patients across the healthcare ecosystem, and among our teams. By building strong, trusted relationships, we create a unified community focused on advancing patient care and physician well-being.
Leadership
We lead with integrity and vision, setting the standard for excellence in physician support and healthcare innovation. Through collaboration and expertise, we empower others to lead, drive change, and shape the future of care.
Excellence
We are relentlessly focused, results-driven, and accountable for delivering measurable value to physicians and the patients they serve. Our high standards reflect our commitment to excellence, operational discipline, and continuous improvement.
Agility
We embrace change as a constant and respond swiftly to the evolving needs of the healthcare industry. With flexibility and forward-thinking, we adapt, innovate, and act decisively to keep physicians at the forefront.
Altais values the contribution each Team Member brings to our organization. Final determination of a successful candidate’s starting pay will vary based on several factors, including, but not limited to education and experience within the job or the industry. The pay scale listed for this position is generally for candidates that meet the specified qualifications and requirements listed on this job description. Additional pay may be determined for those candidates that exceed these specified qualifications and requirements. We provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.
The anticipated pay range for this role is listed in our salary posting for transparency but may vary based on factors including the candidate’s qualifications, skills, and experience.
Altais and its subsidiaries and affiliates are committed to protecting the privacy and security of the personal information you provide to us. Please refer to our ‘CPRA Privacy Notice for California Employees and Applicants’ to learn how we collect and process your personal information when you apply for a role with us.
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
