Credentialing & Licensing Manager

United StatesRemotefull-time

Zivian's mission is to expand access to high-quality healthcare. Our expert guidance and software solutions simplify compliance, improve clinical quality, and streamline management of healthcare teams. This helps independent providers and healthcare organizations stay focused on their core competence: patient care. We believe that a successful consumer product begins with a great experience for our users, and we are dedicated to building innovative tools and platforms that empower healthcare professionals and consumers alike, providing seamless access to resources, removing administrative burden, increasing compliance and insights that enhance health outcomes.Who You Are:You're a credentialing expert who thinks strategically and executes with precision. You understand the complexities of NCQA credentialing and payor enrollment inside and out, and you're excited by the opportunity to redesign and elevate how credentialing works at a fast-growing healthtech company. You thrive at the intersection of operations, technology, and compliance—and you're energized by building scalable systems, not just maintaining them. You're a natural collaborator who can work cross-functionally with Product and Operations teams while also leading and developing a team of your own. What you'll do: Strategic Leadership & Program Design<ul data-pattern="discCircleSquare" data-depth="1" style="font-family:"><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">Own the vision and roadmap for credentialing and licensing at Zivian, transforming the function from transactional to a strategic driver of provider success and organizational growth.</li><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">Redesign and rebuild credentialing workflows end-to-end—identifying gaps, eliminating bottlenecks, and implementing scalable, best-in-class processes.</li><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">Serve as Zivian's internal subject matter expert on NCQA credentialing standards, payor enrollment requirements, and state licensing regulations.</li><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">Partner closely with Product to shape and inform the credentialing and licensing features of Zivian's software platform, translating operational needs into product requirements.</li><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">Collaborate with the broader Operations team to ensure credentialing workflows integrate seamlessly with provider onboarding, engagement, and compliance processes.</li></ul><h3>Credentialing & Licensing Operations</h3><ul data-pattern="discCircleSquare" data-depth="1" style="font-family:"><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">Oversee end-to-end credentialing processes for providers, including initial credentialing, re-credentialing, and payor enrollment.</li><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">Ensure compliance with NCQA guidelines, CMS requirements, state licensing regulations, and payor-specific credentialing standards.</li><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">Manage and monitor expirable tracking for licenses, certifications, and accreditations—ensuring proactive renewals with no lapses.</li><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">Maintain accurate, complete, and audit-ready credentialing files in compliance with HIPAA and applicable privacy regulations.</li><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">Lead, manage, and develop a team of Licensing Specialists, fostering a high-performance culture rooted in quality, accountability, and continuous improvement.</li><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">Build and maintain SOPs and process documentation to standardize credentialing operations across the team.</li><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">Leverage credentialing systems and databases to ensure data integrity and generate reports for leadership and external stakeholders.</li><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">Identify systemic process gaps and implement documented improvements to accelerate speed and reduce error rates.</li></ul> What You'll Bring:<ul data-pattern="discCircleSquare" data-depth="1" style="font-family:"><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">5+ years of experience in credentialing, medical staff services, or provider enrollment, with at least 2 years in a management or team lead role.</li><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">Deep, hands-on knowledge of NCQA credentialing standards and payor credentialing/enrollment processes—this is a must.</li><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">Proven ability to lead, develop, and hold accountable a team of credentialing professionals.</li><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">A builder's mindset: you're not just here to maintain the status quo, but to redesign and improve how credentialing works.</li><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">Strong cross-functional collaboration skills—you can work effectively with Product, Operations, and external stakeholders alike.</li><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">Excellent organizational skills and ruthless attention to detail; you don't let things fall through the cracks.</li><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">Comfort with technology and credentialing systems; ability to quickly learn and adapt to new platforms.</li><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">Strong written and verbal communication skills—you can translate complex regulatory requirements into clear, actionable guidance.</li><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">Ability to balance strategic thinking with hands-on execution in a fast-paced, startup environment.</li><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">Bachelor's degree in Healthcare Administration, Business, or a related field preferred; CPCS or CPMSM certification a plus.</li></ul> Where You'll Be:We offer flexibility in your work location! For this role, you just need to be based within the US, allowing you to work where you feel most productive.<h4 style="font-family:">Our Core Values: </h4><ol data-pattern="deciLoAlphaLoRom" data-depth="1" style="font-family:"><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;text-align:start;">Build with Intention: </li><li style="font-size:11pt;list-style:none;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;text-align:start;"><ul data-pattern="discCircleSquare" data-depth="2" style="font-family:"><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">We stay focused on the work that matters most. No chasing shiny objects. We choose our priorities carefully and follow through with purpose and discipline.</li></ul></li><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;text-align:start;">Trust and Be Trusted: </li><li style="font-size:11pt;list-style:none;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;text-align:start;"><ul data-pattern="discCircleSquare" data-depth="2" style="font-family:"><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">We earn trust by being obsessed with our customers' problems. We listen, we move fast, and we do what we say we're going to do, every time.</li></ul></li><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;text-align:start;">Lift as we climb:</li><li style="font-size:11pt;list-style:none;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;text-align:start;"><ul data-pattern="discCircleSquare" data-depth="2" style="font-family:"><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">We show up for each other. We share context, lend a hand, and celebrate wins. When we lift the people around us, we elevate what's possible for all of us.</li></ul></li></ol><h3>What Zivian Has for You:</h3><ul data-pattern="discCircleSquare" data-depth="1" style="font-family:"><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">A dynamic, diverse, and collaborative work environment.</li><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">Fast-paced startup culture full of growth-minded colleagues.</li><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">A distributed team with opportunities for in-person collaboration.</li><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">Employee equity pool.</li><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">Competitive compensation and benefits package.</li><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">A supportive, non-competitive work environment where the team truly cares about one another.</li><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">Opportunities for continuous learning and professional growth.</li><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;">Flexibility in work location.</li></ul>At Zivian, we live by the value Trust and be Trusted. To protect the integrity of our team and the sensitive data of our healthcare partners, we maintain a rigorous verification process. Zivian participates in E-Verify and utilizes advanced background and identity validation tools for all candidates. Please note that providing fraudulent information or misrepresenting your identity at any stage of the application process is grounds for immediate disqualification. Originally posted on <a href="https://himalayas.app">Himalayas</a>

Credentialing & Licensing Manager

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