Modern Health - Credentialing Program Lead
Requirements
• 5+ years of experience leading and optimizing credentialing programs, provider operations, provider enrollment, licensing, or a related healthcare operations function • Experience administering Credentialing Committee activities, provider governance processes, audits, and regulatory reviews. • Knowledge of credentialing and recredentialing standards, including NCQA, URAC, state regulatory requirements, and delegated credentialing arrangements. • Experience improving credentialing infrastructure, policies, workflows, controls, or operating models in a growing environment • Experience with credentialing software, provider data management systems, primary source verification tools, CAQH, NPDB, provider lifecycle management platforms and credentialing documentation requirements. • Experience supporting audits, accreditation readiness, delegated credentialing oversight, or similar compliance programs • Strong program management, analytical, and cross-functional communication skills • Comfortable balancing strategic process improvement with hands-on operational execution. • Applicants must be able to maintain work authorization for the duration of employment without employer sponsorship or employer-provided training plans or attestations (including, for example, the Form I-983 required for STEM OPT). Immigration sponsorship is not available for this position. • Experience in digital health, telehealth, behavioral health, or a multi-state provider network environment • Experience with credentialing platforms, provider data systems, or vendor oversight • Certified Provider Credentialing Specialist (CPCS), Certified Professional Medical Services Management (CPMSM), or equivalent credentialing certification preferred. • What Success Looks Like
Responsibilities
• Lead and optimize Modern Health’s credentialing program, including initial credentialing, recredentialing, ongoing monitoring, exception handling, and documentation standards • Lead the administration and operations of the Credentialing Committee, including agenda development, case preparation, primary source verification review, documentation management, meeting facilitation, decision tracking, and follow-up activities. • Ensure credentialing and recredentialing activities are conducted in accordance with organizational policies, accreditation standards, regulatory requirements, and the enterprise quality governance structure. • Improve and scale policies, SOPs, controls, and governance processes aligned with regulatory and accreditation requirements • Define and refine program goals, SLAs, metrics, and reporting to monitor timeliness, quality, audit readiness, and operational performance • Streamline workflows for licensure, sanctions, exclusions, malpractice, expirables, renewals, and issue resolution • Serve as a key liaison across Provider Operations, Clinical Quality, Compliance, Legal, and Recruiting/Onboarding to strengthen provider credentialing oversight, mitigate organizational risk, support audit readiness, and drive accountability to Quality Committee priorities. • Identify process, tooling, and vendor opportunities that improve scalability, visibility, and provider experience • Serve as the credentialing SME for audits, escalations, governance reviews, and credentialing-related provider status decisions • Support day-to-day credentialing operations while driving a more scalable future-state model • Improved key credentialing policies, SOPs, and audit-ready documentation • Strengthened SLAs, reporting, and governance mechanisms • Regulatory-compliance credentialing, recredentialing, and ongoing monitoring • Increased cross-functional alignment across Provider Operations, Clinical Quality, Compliance, Legal, and Recruiting / Onboarding • Improved scalability, consistency, and operational execution as the provider network grows
Benefits
• Medical / Dental / Vision / Disability / Life Insurance • High Deductible Health Plan with Health Savings Account (HSA) option • Flexible Spending Account (FSA) • Access to coaches and therapists through Modern Health's platform • Generous Time Off • Company-wide Collective Pause Days • Family Support: • Parental Leave Policy • Family Forming Benefit through Carrot • Family Assistance Benefit through UrbanSitter • Professional Development: • Professional Development Stipend • Financial Wellness: • Financial Planning Benefit through Origin • But wait there’s more…! • Annual Wellness Stipend to use on items that promote your overall well being • New Hire Stipend to help cover work-from-home setup costs • ModSquad Community: Virtual events like active ERGs, holiday themed activities, team-building events and more • Monthly Cell Phone Reimbursement • Equal Pay for Equal Work Act Information • Please refer to the ranges below to find the starting annual pay range for individuals applying to work remotely from the following locations for this role. • Zone 1: San Francisco Bay Area and New York City Metro • Zone 2: All other California locations and Seattle, WA • Zone 3: All other New York locations, All other Washington locations, Washington DC, Austin,TX, CT, IL, MA, NH, NJ, OR, RI, VT • Zone 4: All other Texas locations, AL, AK, AZ, AR, CO, DE, FL, GA, HI, ID, IN, IA, KS, KY, LA, ME, MD, MI, MN, MS, MO, MT, NE, NV, NM, NC, ND, OH, OK, PA, SC, SD, TN, UT, VA, WV, WI, WY • Compensation for the role will depend on a number of factors, including a candidate's qualifications, skills, competencies, and experience and may fall outside of the range shown. Ranges are not necessarily indicative of the associated starting pay range in other locations. Full-time employees are also eligible for Modern Health's equity program and incredible benefits package. See our Careers page for more information. • Depending on the scope of the role, some ranges are indicative of On Target Earnings (OTE) and includes both base pay and commission at 100% achievement of established targets. • $121,600—$143,000 USD • $109,440—$128,700 USD • $97,280—$114,400 USD • $91,163—$107,250 USD • Below, we are asking you to complete identity information for the Equal Employment Opportunity Commission (EEOC). While we are required by law to ask these questions in the format provided by the EEOC, at Modern Health we know that gender is not binary, and we recognize that these categories do not reflect our employees' full range of identities.
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