Paradigm Specialty Networks is seeking an experienced Credentialing Operations Manager to lead and continuously improve our clinician and facility credentialing and recredentialing programs. This full-time, exempt role is responsible for ensuring compliance with regulatory and accreditation standards while driving efficient, accurate, and timely credentialing operations across the organization.

Reporting to the VP of Strategic Initiatives & Execution, the Credentialing Operations Manager partners closely with internal teams, providers, facilities, and delegated entities to support audit readiness, policy development, and process improvement initiatives. This position plays a critical role in maintaining high-quality standards and supporting enterprise-wide operational excellence.

This is a full-time hybrid position, with an expectation to report to the Tampa office as needed.

Responsibilities:

Credentialing of Clinicians and Facilities:

• Oversee and manage the initial credentialing process for all clinicians (physicians, advanced practice providers, allied health professionals) and healthcare facilities.
• Ensure all applications and supporting documentation are collected, verified, and maintained according to organizational policies and regulatory requirements.
• Coordinate and communicate with providers, facilities, and internal teams to resolve discrepancies and expedite credentialing timelines.

Recredentialing Process:

• Lead and manage periodic recredentialing of clinicians and facilities in compliance with organizational, state, and federal guidelines.
• Monitor upcoming recredentialing deadlines and proactively communicate with providers and facilities to ensure timely completion.
• Analyze data and develop process improvements to streamline recredentialing activities and enhance compliance.

Delegation Audit Management:

• Develop and implement audit tools and protocols to assess delegated entities' compliance with credentialing standards.
• Conduct regular delegation audits, document findings, and report results to leadership and relevant stakeholders.
• Provide guidance and corrective action plans for delegated entities not meeting performance or compliance expectations.

Policy and Procedure Development:

• Maintain and update credentialing and recredentialing policies to reflect current regulations and best practices.
• Train and support credentialing staff on policies, procedures, and regulatory changes.

Compliance:

• Ensure all credentialing activities align with NCQA, URAC, The Joint Commission, and other relevant accreditation standards.
• Prepare for and participate in internal and external audits and surveys.

Stakeholder Communication:

• Act as a primary point of contact for credentialing inquiries from providers, facilities, internal departments, and regulatory agencies.
• Provide regular updates and reports on credentialing status, compliance metrics, and audit outcomes to senior leaders.

Key competencies:

• Leadership and team management
• Process improvement and project management
• Regulatory compliance and audit readiness
• Problem-solving and critical thinking
• Interpersonal and stakeholder relationship skills
• Responsible for complying with Paradigm Information Security requirements and policies, for safeguarding Paradigm or Paradigm related passwords, and for notifying Paradigm of any Information Security incidents per policy SEC 10-12 Information Security Incident Management.

Supervisory Responsibilities:

• Mentor, train, and supervise team members directly and indirectly, review their work and provide effective constructive feedback to achieve their best performance and goal attainment
• Set the tone for a strong Enterprise culture and high employee engagement.
• Ensure all team members understand, are trained in, and comply with Paradigm’s security requirements and policies.
• Ensure all team members have the minimum level of IT system access required to effectively complete their Paradigm responsibilities.

Qualifications:

• Educational background: Bachelor’s degree in healthcare administration, business, or a related field (Master’s preferred).
• Experience: Minimum of 3–5 years of experience in credentialing operations, with at least 2 years in a leadership or management role.
• Thorough understanding of credentialing requirements, accreditation standards, and regulatory guidelines (e.g., NCQA, URAC, CMS, The Joint Commission).
• Technical skills: proficiency in Microsoft Office suite (Excel, PowerPoint, Word), data visualization tools (e.g. Power BI).
• Analytical skills: strong ability to analyze complex data sets and derive actionable insights.
• Communication skills: exceptional written and verbal communication skills, with the ability to simplify complex topics for diverse audiences.
• Experience with credentialing software and data management systems.
• Collaboration: proven ability to work collaboratively with cross-functional teams in a fast-paced environment.
• Attention to detail: strong focus on accuracy and thoroughness in all deliverables.