Curana Health is a provider of value-based primary care services for the senior living industry, including skilled nursing facilities, assisted & independent living communities, Memory Care units, and affordable senior housing sites. Our 1,000+ clinicians serve more than 1,500 senior living community partners across 34 states, and Curana participates in various innovative CMS programs (including owned-and-operated Accountable Care Organizations and Medicare Advantage plans). With rapid year-over-year growth since our founding in 2021, Curana is setting a new standard in innovative care delivery for seniors with high-risk, complex clinical needs, many of whom have been historically underserved by the healthcare system. Our mission: To radically improve the health, happiness and dignity of senior living residents.

Job Summary:

The Provider Network Credentialing Manager will lead and oversee all aspects of the credentialing process in alignment with CMS, NCQA, state, and insurance standards. This key leadership role is essential to the provider network and directly supports the organization’s ability to grow and expand into new markets. The ideal candidate will bring both strategic insight and operational expertise to drive efficiency, shape departmental policies, and guide the continued development of an internal credentialing team.

Responsibilities:

• Lead the end-to-end practitioner credentialing process, ensuring timely and accurate completion of provider credentialing and recredentialing in accordance with regulatory and organizational requirements.
• Supervise and report on provider file management, team workflows, production benchmarks, quality assurance, and adherence to credentialing timelines.
• Develop, implement, and maintain credentialing policies and procedures to ensure compliance with CMS, NCQA, and state requirements.
• Provide regular reporting and updates to leadership, including Executive Directors and Account Managers, on credentialing operations, provider status, departmental performance, and improvement opportunities.
• Monitor and continuously improve credentialing processes to ensure consistency, quality, and efficiency across the department.
• Manage credentialing system updates to ensure accurate provider status is maintained within the Provider Data Management system.
• Ensure timely generation, tracking, and delivery of credentialing correspondence, including approvals, denials, requests for information, and follow-ups.
• Collaborate with data management and IT teams to ensure smooth integration and operation of credentialing systems.
• Research and resolve credentialing issues, identifying and implementing process improvements to prevent recurrence.
• Ensure all credentialing compliance requirements are met by the professional credentialing specialists including but not limited to initial credentialing, recredentialing and ongoing monitoring.
• Maintain and prepare documentation for the Credentialing Committee, present credentialing recommendations, and manage meeting agendas.
• Ensure clear, timely communication to providers and internal teams when a provider’s credentialing status changes.
• Conduct outreach to providers to obtain necessary documentation for credentialing and recredentialing.
• Oversee submission and internal QA of provider applications and ensure proper documentation is maintained for all credentialing actions.
• Train and support new staff, Medical Directors, and plan partners on the credentialing process and tools used within the department.

Knowledge & Skills Required:

• Bachelor's degree or equivalent combination of education and healthcare experience.
• Minimum of 7 years of experience in managed care organization settings.
• At least 5 years of direct experience with provider credentialing and contracting.
• Deep knowledge of physician credentialing standards as defined by CMS and state Medicaid agencies.
• Proven experience in managing performance credentialing operations.
• Strong written and verbal communication skills, with the ability to engage across all organizational levels and external partners.
• Proficient in Microsoft Office Suite and credentialing management systems.

Curana Health is dedicated to the principles of Equal Employment Opportunity. We affirm, in policy and practice, our commitment to diversity. We do not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable or state law, genetic information, or any other characteristic protected by applicable federal, state and local laws and ordinances.

The EEO policy applies to all personnel matters as outlined in our company policy including recruitment, hiring, transfers, and general treatment during employment.

*The company is unable to provide sponsorship for a visa at this time (H1B or otherwise).