Director, Credentialing Operations
TriWest Healthcare Alliance, Phoenix, AZ, United States
Profile
Remote work opportunities in AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only.
Department of Defense contract requires U.S. citizenship and a favorably adjudicated DOD background investigation.
Veterans, Reservists, Guardsmen and military family members are encouraged to apply.
Job Summary Responsible for leading and overseeing the operational performance of provider credentialing functions, including end‑to‑end credentialing and re‑credentialing processes, delegated credentialing oversight, ongoing monitoring, and provider data maintenance. Ensures timely and compliant credentialing operations through effective management of work production, service level agreements (SLAs), workload distribution, and performance metrics. Directs credentialing staff and external partners to meet operational targets while maintaining high standards for quality assurance. Oversees credentialing system operations, staff training and development, and continuous process improvement to optimize efficiency and accuracy. Leads the coordination and governance of credentialing committee activities and ensures consistent execution of credentialing policies and procedures. Monitors operational performance, implements corrective actions when needed, and drives accountability for quality, timeliness, and overall credentialing effectiveness across the organization. Represents the organization with professionalism and integrity in interactions with providers, vendors, and regulatory bodies, serving as a role model for leadership and organizational values both internally and externally.
Education & Experience Required:
Bachelor’s degree in business administration, healthcare administration, or related field or equivalent experience
U.S. Citizen
Must receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
5 years of experience in a managed care or payer environment
5+ years of progressively responsible people management experience including managing leaders in the healthcare industry
Minimum of 3 years of experience managing provider credentialing and data applications/systems
Proven experience leading and managing large teams in a high-volume, production-driven environment
Experience with URAC, NCQA, or other equivalent accreditation standards
Experience in strategic planning, program design and management, and team leadership with a focus on leadership and staff development
Preferred:
Experience in government healthcare delivery programs, such as Veterans Affairs, TRICARE, or Medicare
Key Responsibilities
Provides strategic leadership and operational oversight for the Provider Network Management – Credentialing Department, ensuring alignment with organizational goals, regulatory requirements, and accreditation standards.
Leads, mentors, and develops staff to achieve high performance, accountability, and continuous improvement.
Directs end-to-end credentialing and re-credentialing operations, ensuring timely completion of activities in accordance with SLAs and regulatory requirements.
Oversees departmental productivity, work production, workload distribution, and operational performance via KPI development and monitoring.
Ensures quality, accuracy, and integrity of credentialing and provider data across systems, including oversight of primary source verification and data entry.
Establishes and maintains robust quality assurance and audit processes to meet internal and regulatory standards.
Oversees end-to-end delegated credentialing program, governing, monitoring, and auditing network subcontractors and delegated entities, and directing audit reviews and corrective actions.
Oversees the coordination and administration of Credentialing Committee activities, ensuring accurate files and adherence to governance policies.
Identifies operational risks and workflow inefficiencies within credentialing processes and drives process improvements and system enhancements.
Collaborates cross-functionally with Provider Services, Compliance, Legal, Medical Management, IT, and other operational areas to support enterprise initiatives.
Fosters strong relationships with network providers, delegated entities, and internal stakeholders to resolve credentialing issues and support a positive provider experience.
Develops and delivers executive-level performance reports and dashboards for senior leadership.
Establishes staffing strategies and allocates resources to meet service level commitments; recruits, trains, coaches, and develops staff.
Assesses and defines budgetary requirements for departmental objectives, recommends funding needs, and forecasts resources aligned with industry trends.
Maintains regular attendance and demonstrates leadership reflecting organizational values.
Competencies Coaching / Training / Mentoring:
Leads team development through coaching, mentoring, and targeted training; provides ongoing feedback to enhance performance, build credentialing expertise, and ensure alignment with organizational goals.
Communication / People Skills:
Effectively influences and aligns stakeholders across all levels, adapting communication style to diverse audiences and situations; demonstrates strong active listening and collaboration skills to resolve issues, build consensus, and drive operational outcomes.
Computer Literacy:
Demonstrates advanced proficiency in a multi-system environment, including Microsoft Office and credentialing platforms.
Coping / Flexibility:
Demonstrates resilience and flexibility in changing priorities, complex situations, and diverse stakeholders.
Empathy / Customer Service:
Promotes a provider- and stakeholder-centric approach by demonstrating empathy, active listening, and professionalism.
Independent Thinking / Self-Initiative:
Demonstrates strong critical thinking and good judgment to prioritize high-impact work and drive results.
Information Management:
Effectively manages and synthesizes complex credentialing and provider data to support accurate decision making.
Leadership:
Provides clear direction and strategic guidance while leading and developing diverse employees.
Multi-Tasking / Time Management:
Effectively prioritizes high-volume credentialing activities to meet deadlines and SLAs.
Problem Solving / Analysis:
Applies structured, data-driven analysis to identify root causes and implement sustainable solutions.
Team-Building / Team Player:
Builds high-performing teams by fostering collaboration and shared commitment.
Technical Skills:
Deep expertise in provider credentialing principles, practices, and systems; strong knowledge of regulatory and accreditation requirements.
Working Conditions
Availability to cover any work shift as needed.
Travel may be required.
May work within a standard office environment.
Extensive time utilizing a computer with prolonged sitting.
Must obtain appropriate security clearance.
Benefits
Medical, Dental and Vision Coverage
Paid time off
401(k) Retirement Savings Plan (with matching)
Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
Tuition reimbursement
Paid volunteer time
Salary range: $153,000 to $161,000 per year.
Equal Employment Opportunity: TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment supporting diversity at every level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit, without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.
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Department of Defense contract requires U.S. citizenship and a favorably adjudicated DOD background investigation.
Veterans, Reservists, Guardsmen and military family members are encouraged to apply.
Job Summary Responsible for leading and overseeing the operational performance of provider credentialing functions, including end‑to‑end credentialing and re‑credentialing processes, delegated credentialing oversight, ongoing monitoring, and provider data maintenance. Ensures timely and compliant credentialing operations through effective management of work production, service level agreements (SLAs), workload distribution, and performance metrics. Directs credentialing staff and external partners to meet operational targets while maintaining high standards for quality assurance. Oversees credentialing system operations, staff training and development, and continuous process improvement to optimize efficiency and accuracy. Leads the coordination and governance of credentialing committee activities and ensures consistent execution of credentialing policies and procedures. Monitors operational performance, implements corrective actions when needed, and drives accountability for quality, timeliness, and overall credentialing effectiveness across the organization. Represents the organization with professionalism and integrity in interactions with providers, vendors, and regulatory bodies, serving as a role model for leadership and organizational values both internally and externally.
Education & Experience Required:
Bachelor’s degree in business administration, healthcare administration, or related field or equivalent experience
U.S. Citizen
Must receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
5 years of experience in a managed care or payer environment
5+ years of progressively responsible people management experience including managing leaders in the healthcare industry
Minimum of 3 years of experience managing provider credentialing and data applications/systems
Proven experience leading and managing large teams in a high-volume, production-driven environment
Experience with URAC, NCQA, or other equivalent accreditation standards
Experience in strategic planning, program design and management, and team leadership with a focus on leadership and staff development
Preferred:
Experience in government healthcare delivery programs, such as Veterans Affairs, TRICARE, or Medicare
Key Responsibilities
Provides strategic leadership and operational oversight for the Provider Network Management – Credentialing Department, ensuring alignment with organizational goals, regulatory requirements, and accreditation standards.
Leads, mentors, and develops staff to achieve high performance, accountability, and continuous improvement.
Directs end-to-end credentialing and re-credentialing operations, ensuring timely completion of activities in accordance with SLAs and regulatory requirements.
Oversees departmental productivity, work production, workload distribution, and operational performance via KPI development and monitoring.
Ensures quality, accuracy, and integrity of credentialing and provider data across systems, including oversight of primary source verification and data entry.
Establishes and maintains robust quality assurance and audit processes to meet internal and regulatory standards.
Oversees end-to-end delegated credentialing program, governing, monitoring, and auditing network subcontractors and delegated entities, and directing audit reviews and corrective actions.
Oversees the coordination and administration of Credentialing Committee activities, ensuring accurate files and adherence to governance policies.
Identifies operational risks and workflow inefficiencies within credentialing processes and drives process improvements and system enhancements.
Collaborates cross-functionally with Provider Services, Compliance, Legal, Medical Management, IT, and other operational areas to support enterprise initiatives.
Fosters strong relationships with network providers, delegated entities, and internal stakeholders to resolve credentialing issues and support a positive provider experience.
Develops and delivers executive-level performance reports and dashboards for senior leadership.
Establishes staffing strategies and allocates resources to meet service level commitments; recruits, trains, coaches, and develops staff.
Assesses and defines budgetary requirements for departmental objectives, recommends funding needs, and forecasts resources aligned with industry trends.
Maintains regular attendance and demonstrates leadership reflecting organizational values.
Competencies Coaching / Training / Mentoring:
Leads team development through coaching, mentoring, and targeted training; provides ongoing feedback to enhance performance, build credentialing expertise, and ensure alignment with organizational goals.
Communication / People Skills:
Effectively influences and aligns stakeholders across all levels, adapting communication style to diverse audiences and situations; demonstrates strong active listening and collaboration skills to resolve issues, build consensus, and drive operational outcomes.
Computer Literacy:
Demonstrates advanced proficiency in a multi-system environment, including Microsoft Office and credentialing platforms.
Coping / Flexibility:
Demonstrates resilience and flexibility in changing priorities, complex situations, and diverse stakeholders.
Empathy / Customer Service:
Promotes a provider- and stakeholder-centric approach by demonstrating empathy, active listening, and professionalism.
Independent Thinking / Self-Initiative:
Demonstrates strong critical thinking and good judgment to prioritize high-impact work and drive results.
Information Management:
Effectively manages and synthesizes complex credentialing and provider data to support accurate decision making.
Leadership:
Provides clear direction and strategic guidance while leading and developing diverse employees.
Multi-Tasking / Time Management:
Effectively prioritizes high-volume credentialing activities to meet deadlines and SLAs.
Problem Solving / Analysis:
Applies structured, data-driven analysis to identify root causes and implement sustainable solutions.
Team-Building / Team Player:
Builds high-performing teams by fostering collaboration and shared commitment.
Technical Skills:
Deep expertise in provider credentialing principles, practices, and systems; strong knowledge of regulatory and accreditation requirements.
Working Conditions
Availability to cover any work shift as needed.
Travel may be required.
May work within a standard office environment.
Extensive time utilizing a computer with prolonged sitting.
Must obtain appropriate security clearance.
Benefits
Medical, Dental and Vision Coverage
Paid time off
401(k) Retirement Savings Plan (with matching)
Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
Tuition reimbursement
Paid volunteer time
Salary range: $153,000 to $161,000 per year.
Equal Employment Opportunity: TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment supporting diversity at every level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit, without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.
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