Senior Director – Credentialing
knownwell
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $160,000 - $190,000 per year
Job Level
Senior
About the role
- Define and own the enterprise-wide strategy for payor contracting, credentialing, and licensing to support scalable growth across 50 states.
- Serve as a key member of the leadership team, regularly engaging with C-suite executives to align on business goals, clinical partnerships, and market expansion strategy.
- Design and implement a scalable operational infrastructure (people, process, technology) for contracting, credentialing, and licensing functions.
- Lead contracting strategies to secure competitive terms with Commercial, Medicare Advantage, and Managed Medicaid plans, including Value-Based Care models.
- Partner closely with legal, operations, growth, and clinical leadership to support service line expansion, new market entry, and integration with CINs/IPAs.
- Lead national and regional negotiations with health plans, managing relationships across multiple geographies and payor types.
- Develop robust payor segmentation and targeting strategies based on value, access, and growth priorities.
- Oversee contract lifecycle management, including pipeline development, rate analysis, renewals, escalations, and performance monitoring.
- Establish consistent and compliant contract templates, reimbursement standards, and term guidelines in collaboration with legal and finance teams.
- Serve as subject matter expert on health plan dynamics, market access trends, and reimbursement innovation.
- Build and oversee a centralized team responsible for timely and accurate credentialing of providers and licensure across all 50 states and telehealth requirements.
- Ensure regulatory and payor compliance across all provider enrollment and maintenance workflows.
- Optimize systems, tools, and reporting to increase efficiency, reduce turnaround time, and proactively manage renewals and expirations.
- Act as the enterprise liaison between growth, clinical operations, revenue cycle, compliance, and legal to ensure seamless alignment on contract execution and provider access.
- Provide timely, data-driven updates and insights to executive leadership regarding network coverage, payor performance, credentialing timelines, and strategic risks/opportunities.
- Hire, lead, and mentor a high-performing team with expertise in payor contracting, credentialing, and regulatory compliance.
- Establish clear OKRs and performance metrics for individual and team success.
- Foster a mission-driven, inclusive culture focused on collaboration, accountability, and continuous improvement.
Requirements
- 10–15+ years of experience in healthcare payor contracting, credentialing, and licensing leadership roles.
- Proven track record negotiating provider contracts with national and regional payors (Commercial, MA, and Medicaid).
- Track record putting delegated credentialing agreements in place and operationalizing with CVOs.
- Deep knowledge of telehealth and multi-state regulatory requirements.
- Experience leading functions that support both virtual and clinic-based care delivery models.
- Prior leadership experience in high-growth, fast-paced healthcare organizations (e.g., value-based providers, MSOs, payors, or health tech startups).
- Experience working in or closely with CINs, ACOs, or IPAs preferred.
- Proficiency with contract management systems and credentialing platforms.
- Bachelor’s degree required; MBA, MHA, or JD preferred.
Benefits
- 💻 Fully remote opportunity
- 🩺 Medical, dental, and vision insurance
- 📈 401K retirement plan with company match
- 🏝️ Up to 20 days of PTO per year + company holidays
- 👶 Up to 14 weeks of paid parental leave (12 for non-birthing parents)
- 🏡 Annual work from home stipend for remote employees
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
payor contractingcredentialinglicensingcontract lifecycle managementnegotiationrate analysisreimbursement standardsvalue-based caretelehealth requirementsregulatory compliance
Soft skills
leadershipcollaborationaccountabilitycontinuous improvementmentoringstrategic thinkingdata-driven decision makingcommunicationteam buildingproblem solving
Certifications
Bachelor's degreeMBAMHAJD