Director, Credentialing Verification Organization
HealthStream, Nashville, TN, United States
Overview
HealthStream is the leader in healthcare workforce solutions. We help organizations work better by helping their people work smarter.
HealthStream provides the leading learning, clinical development, credentialing, and scheduling applications delivered on healthcare’s #1 platform. We streamline everyday tasks while improving performance, engagement, and safety – fostering a workplace where people flourish, and care thrives.
Why Join Us
At HealthStream, you’ll have the opportunity to make a meaningful impact on the future of healthcare by collaborating with a team of talented professionals dedicated to innovation and excellence. We offer competitive compensation, comprehensive benefits, and a supportive work environment where creativity and collaboration thrive.
Our shared vision is to enhance the quality of healthcare by empowering the people who deliver care – a commitment we have upheld for over 30 years through providing innovative solutions and driving constant growth. Join us in revolutionizing the healthcare industry and shaping the future of patient care. As a HealthStreamer, you will be at the forefront of healthcare technology innovation, making a recurring impact on the industry.
We’re proud of our values-forward culture that offers our people:
Mission-oriented work
Diverse and inclusive culture
Competitive Compensation & Bonuses
Comprehensive Insurance Plans
Mental and Physical Health Support
Work-from-home flexibility
Fitness Center Reimbursements
Streaming Good time off for volunteering
Wellness workshops
Buddy Program for new HealthStreamers
Collaborative work environment
Career growth opportunities
Continuous learning opportunities
Inspiring workspaces to collaborate and connect with other HealthStreamers
Free employee parking at our Resource Centers in Nashville and San Diego
At HealthStream, our thriving culture encourages collaboration and values contributions, allowing our team members to continuously solve big problems and grow. We offer flexibility and paid time off to support work-life integration for all employees, including a hybrid work environment and Streaming Good volunteer day. For team members in commutable distance, HealthStream has Resource Centers in Nashville, TN and San Diego, CA. Our resource centers provide an inspiring workspace to collaborate and recharge as well as company-sponsored onsite social events for development, connection, and celebration.
We are committed to driving innovation in healthcare and ensuring that patients receive competent care from qualified professionals. As a HealthStream team member, you will help bring this vision to life. If you want to work for a company committed to its values and vision, HealthStream is the place for you!
HealthStream is an equal opportunity employer. HealthStream prohibits employment practices that discriminate against individual employees or groups of employees on the basis of age, color, disability, national origin, race, religion, sex, sexual orientation, pregnancy, veteran or military status, genetic information or any other category deemed protected by state and/or federal law.
Position Information Position Overview
Lead HealthStream\'s Credentialing Verification Organization (CVO) operations while partnering with Product Development to adopt and operationalize the next-generation credentialing suite. This role is responsible for maintaining NCQA certification and delivering high-quality credentialing services while driving operational improvements through new technology and process optimization.
Key Responsibilities You will be responsible for adhering to all HealthStream security policies, procedures, and assigned training.
Provide strategic leadership to the CVO.
Direct all CVO credentialing operations, ensuring adherence to NCQA certification standards, delegated credentialing requirements, and client-specific SLAs
Chair the CVO Quality Committee and own the quality management program including corrective action and continuous improvement
Lead NCQA survey preparation and maintain survey-ready operations year-round; act as a liaison with the NCQA, TJC and related accreditation organizations.
Serve as subject matter expert on credentialing standards and maintain working knowledge of regulatory requirements from NCQA, TJC, AAAHC, and related accrediting organizations; translate regulatory changes and industry best practices into operational policy updates.
Partner with the Operations Manager to ensure day-to-day operational continuity, staff development and workload management
Develop and maintain CVO policies, procedures, training and compliance documentation
Manage the CVO operational budget with attention to revenue growth, margin improvement, cost-per-verification and operational efficiency
Identify opportunities to transform credentialing workflows through automation and technology adoption, including artificial intelligence; determine which processes are candidates for automation and which require manual oversight
Partner with Product Management and Engineering to prioritize platform capabilities based on operational impact and feasibility; Serve as a primary internal stakeholder for HealthStream\'s credentialing application
Define and track operational KPIs, dashboards, and reporting to measure CVO performance, identify quality issues or bottlenecks, and support capacity planning
Provide regular operational reporting to leadership with actionable insights
Collaborate with Sales leadership to support pipeline activity, provide operational feasibility input on prospective deals, and participate in client-facing conversations
Oversee the onboarding of new clients and maintains a relationship with existing clients.
Review, analyze and respond to client inquiries regarding compliance with NCQA, TJC and related accreditation standards
Manage client escalations and serve as the senior operational point of contact for complex or high-risk credentialing issues
Work with HealthStream Legal Department and Salesforce contacts to manage new and existing CVO services and products
Qualifications
Bachelor\'s degree preferred. In lieu of degree, equivalent work history and years of experience will be considered.
CPMSM or CPSC professional certification required; both preferred.
Minimum 5 years leading credentialing operations at a CVO or large health system
Successfully led or significantly contributed to at least one NCQA accreditation survey cycle.
Strong working knowledge of NCQA, TJC, AAAHC, CMS, and delegated credentialing standards.
Experience with commercial credentialing software platforms; CredentialStream experience strongly preferred.
Demonstrated history of improving credentialing workflows, processes, or operational efficiency
Budget management experience including both revenue and expense accountability.
Experience adopting new technology or leading operational teams through system transitions.
Comfortable partnering with Product Development teams to define requirements and validate solutions.
Familiarity with data and reporting tools to support operational decision-making; experience with BI/analytics platforms a plus.
Project management experience sufficient to manage cross-functional initiatives.
Strong written and verbal communication skills — able to engage credibly with both frontline staff and executive leadership.
Sound judgment and decision-making skills
Deals effectively and calmly with conflict related and/or emotional situations.
Possesses critical thinking and problem-solving skills.
Ability to balance operational continuity with change initiatives
Ability to lead and motivate teams
Ability to track and measure staff performance
Ability to delegate and assign work to others
Ability to plan, organize and manage multiple projects and set priorities.
Able to maintain and develop effective working relationships with clients, providers, leadership, department staff and contacts inside and outside of the CVO
This position is primarily sedentary in a normal office environment.
Extensive computer usage and use of the phone.
Could lift up to 20 lbs.
Accountability - Taking responsibility for one’s actions and the consequences that result from those actions.
Communication & Positive Presence - Listening attentively and respectfully; expressing thoughts and ideas effectively and concisely—both verbally and in writing. Exhibiting a pleasant attitude.
Collaboration - Cooperating and working effectively with others in the pursuit of common goals.
Problem Solving - Using sound judgment, logic, and common sense to identify and/or resolve issues that involve clients/customers, products, and processes.
Adaptability - Being flexible and continuing to function effectively during times of change.
Organizing - Using effective methods for tracking project details, time, and resources in order to complete tasks efficiently and in a timely manner.
Quality Focus - Acting diligently to ensure all aspects of work are completed accurately.
Customer Service - Treating clients/customers with a high level of respect and taking action in order to meet or exceed expectations and resolve problems.
Compensation
The salary range for this position is $101,099 - $124,608. Salary will be determined on the candidate’s level of experience and qualifications. Compensation will be commensurate with skills, relevant experience, and performance in similar roles.
Benefits HealthStream offers a comprehensive benefits package to eligible employees, including:
Medical, Dental and Vision insurance
Paid Time Off
Parental Leave
401k and Roth
Flexible Spending Account
Health Savings Account
Life Insurance
Short- and Long-Term Disability
Medical Bridge Insurance
Critical Illness Insurance
Accident Insurance
Identity Protection
Legal Protection
Pet Insurance
Employee Assistance Program
Fitness Reimbursement
Req #45768
#J-18808-Ljbffr
HealthStream provides the leading learning, clinical development, credentialing, and scheduling applications delivered on healthcare’s #1 platform. We streamline everyday tasks while improving performance, engagement, and safety – fostering a workplace where people flourish, and care thrives.
Why Join Us
At HealthStream, you’ll have the opportunity to make a meaningful impact on the future of healthcare by collaborating with a team of talented professionals dedicated to innovation and excellence. We offer competitive compensation, comprehensive benefits, and a supportive work environment where creativity and collaboration thrive.
Our shared vision is to enhance the quality of healthcare by empowering the people who deliver care – a commitment we have upheld for over 30 years through providing innovative solutions and driving constant growth. Join us in revolutionizing the healthcare industry and shaping the future of patient care. As a HealthStreamer, you will be at the forefront of healthcare technology innovation, making a recurring impact on the industry.
We’re proud of our values-forward culture that offers our people:
Mission-oriented work
Diverse and inclusive culture
Competitive Compensation & Bonuses
Comprehensive Insurance Plans
Mental and Physical Health Support
Work-from-home flexibility
Fitness Center Reimbursements
Streaming Good time off for volunteering
Wellness workshops
Buddy Program for new HealthStreamers
Collaborative work environment
Career growth opportunities
Continuous learning opportunities
Inspiring workspaces to collaborate and connect with other HealthStreamers
Free employee parking at our Resource Centers in Nashville and San Diego
At HealthStream, our thriving culture encourages collaboration and values contributions, allowing our team members to continuously solve big problems and grow. We offer flexibility and paid time off to support work-life integration for all employees, including a hybrid work environment and Streaming Good volunteer day. For team members in commutable distance, HealthStream has Resource Centers in Nashville, TN and San Diego, CA. Our resource centers provide an inspiring workspace to collaborate and recharge as well as company-sponsored onsite social events for development, connection, and celebration.
We are committed to driving innovation in healthcare and ensuring that patients receive competent care from qualified professionals. As a HealthStream team member, you will help bring this vision to life. If you want to work for a company committed to its values and vision, HealthStream is the place for you!
HealthStream is an equal opportunity employer. HealthStream prohibits employment practices that discriminate against individual employees or groups of employees on the basis of age, color, disability, national origin, race, religion, sex, sexual orientation, pregnancy, veteran or military status, genetic information or any other category deemed protected by state and/or federal law.
Position Information Position Overview
Lead HealthStream\'s Credentialing Verification Organization (CVO) operations while partnering with Product Development to adopt and operationalize the next-generation credentialing suite. This role is responsible for maintaining NCQA certification and delivering high-quality credentialing services while driving operational improvements through new technology and process optimization.
Key Responsibilities You will be responsible for adhering to all HealthStream security policies, procedures, and assigned training.
Provide strategic leadership to the CVO.
Direct all CVO credentialing operations, ensuring adherence to NCQA certification standards, delegated credentialing requirements, and client-specific SLAs
Chair the CVO Quality Committee and own the quality management program including corrective action and continuous improvement
Lead NCQA survey preparation and maintain survey-ready operations year-round; act as a liaison with the NCQA, TJC and related accreditation organizations.
Serve as subject matter expert on credentialing standards and maintain working knowledge of regulatory requirements from NCQA, TJC, AAAHC, and related accrediting organizations; translate regulatory changes and industry best practices into operational policy updates.
Partner with the Operations Manager to ensure day-to-day operational continuity, staff development and workload management
Develop and maintain CVO policies, procedures, training and compliance documentation
Manage the CVO operational budget with attention to revenue growth, margin improvement, cost-per-verification and operational efficiency
Identify opportunities to transform credentialing workflows through automation and technology adoption, including artificial intelligence; determine which processes are candidates for automation and which require manual oversight
Partner with Product Management and Engineering to prioritize platform capabilities based on operational impact and feasibility; Serve as a primary internal stakeholder for HealthStream\'s credentialing application
Define and track operational KPIs, dashboards, and reporting to measure CVO performance, identify quality issues or bottlenecks, and support capacity planning
Provide regular operational reporting to leadership with actionable insights
Collaborate with Sales leadership to support pipeline activity, provide operational feasibility input on prospective deals, and participate in client-facing conversations
Oversee the onboarding of new clients and maintains a relationship with existing clients.
Review, analyze and respond to client inquiries regarding compliance with NCQA, TJC and related accreditation standards
Manage client escalations and serve as the senior operational point of contact for complex or high-risk credentialing issues
Work with HealthStream Legal Department and Salesforce contacts to manage new and existing CVO services and products
Qualifications
Bachelor\'s degree preferred. In lieu of degree, equivalent work history and years of experience will be considered.
CPMSM or CPSC professional certification required; both preferred.
Minimum 5 years leading credentialing operations at a CVO or large health system
Successfully led or significantly contributed to at least one NCQA accreditation survey cycle.
Strong working knowledge of NCQA, TJC, AAAHC, CMS, and delegated credentialing standards.
Experience with commercial credentialing software platforms; CredentialStream experience strongly preferred.
Demonstrated history of improving credentialing workflows, processes, or operational efficiency
Budget management experience including both revenue and expense accountability.
Experience adopting new technology or leading operational teams through system transitions.
Comfortable partnering with Product Development teams to define requirements and validate solutions.
Familiarity with data and reporting tools to support operational decision-making; experience with BI/analytics platforms a plus.
Project management experience sufficient to manage cross-functional initiatives.
Strong written and verbal communication skills — able to engage credibly with both frontline staff and executive leadership.
Sound judgment and decision-making skills
Deals effectively and calmly with conflict related and/or emotional situations.
Possesses critical thinking and problem-solving skills.
Ability to balance operational continuity with change initiatives
Ability to lead and motivate teams
Ability to track and measure staff performance
Ability to delegate and assign work to others
Ability to plan, organize and manage multiple projects and set priorities.
Able to maintain and develop effective working relationships with clients, providers, leadership, department staff and contacts inside and outside of the CVO
This position is primarily sedentary in a normal office environment.
Extensive computer usage and use of the phone.
Could lift up to 20 lbs.
Accountability - Taking responsibility for one’s actions and the consequences that result from those actions.
Communication & Positive Presence - Listening attentively and respectfully; expressing thoughts and ideas effectively and concisely—both verbally and in writing. Exhibiting a pleasant attitude.
Collaboration - Cooperating and working effectively with others in the pursuit of common goals.
Problem Solving - Using sound judgment, logic, and common sense to identify and/or resolve issues that involve clients/customers, products, and processes.
Adaptability - Being flexible and continuing to function effectively during times of change.
Organizing - Using effective methods for tracking project details, time, and resources in order to complete tasks efficiently and in a timely manner.
Quality Focus - Acting diligently to ensure all aspects of work are completed accurately.
Customer Service - Treating clients/customers with a high level of respect and taking action in order to meet or exceed expectations and resolve problems.
Compensation
The salary range for this position is $101,099 - $124,608. Salary will be determined on the candidate’s level of experience and qualifications. Compensation will be commensurate with skills, relevant experience, and performance in similar roles.
Benefits HealthStream offers a comprehensive benefits package to eligible employees, including:
Medical, Dental and Vision insurance
Paid Time Off
Parental Leave
401k and Roth
Flexible Spending Account
Health Savings Account
Life Insurance
Short- and Long-Term Disability
Medical Bridge Insurance
Critical Illness Insurance
Accident Insurance
Identity Protection
Legal Protection
Pet Insurance
Employee Assistance Program
Fitness Reimbursement
Req #45768
#J-18808-Ljbffr