Credentialing Program Manager - Remote - Remote Eligible

Credentialing Program Manager

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Credentialing Program Manager will oversee strategic healthcare programs focused on operational optimization, acquisitions and integrations, payer compliance, and adherence to state and federal regulations. This role ensures programs align with organizational goals, key initiatives and growth targets and maintain regulatory compliance while driving efficiency and cost-effectiveness.

You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

Program Oversight & Strategy

• Manage key workstreams that support organizational objectives and key initiatives
• Lead initiatives related to business optimizations and acquisition integration
• Complete change of ownership requests and establish group accounts
• Coordinate with payer contracting on group implementations
• Identify opportunities for process optimization and implement best practices to enhance operational efficiency
• Facilitate meetings, lead process improvement efforts, and ensure accurate project documentation
• Present project updates and strategic recommendations to leadership
• Effective Risk Management by identifying potential risks and develop mitigation strategies to ensure program success

Regulatory & Compliance Management

• Maintain expert-level knowledge of federal, state, and payer regulations
• Ensure department processes and procedures comply with healthcare laws, payer contracts, and accreditation standards
• Develop and monitor internal policies and procedures to maintain compliance

Performance Monitoring & Reporting

• Collaborate with cross-functional teams, including clinical, administrative, and payer relations
• Serve as the primary point of contact for programmatic issues and resolutions
• Implement continuous quality improvement initiatives to enhance internal operational performance
• Develop and deliver training for staff on compliance, payer requirements, and program processes

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• 5+ years in healthcare program management, provider credentialing and experience in payer compliance, state regulations, and acquisition integration
• 3+ years managing, leading or mentoring others
• Proven track record in process optimization and project management

Preferred Qualifications:

• Proven solid knowledge of healthcare regulations, payer requirements, and accreditation standards
• Expertise in project management, data analysis and reporting
• Ability to work in fast-paced environment and meet deadlines
• Proven excellent communication and leadership skills
• Proven excellent organizational skills including detailed documentation and record-keeping
• Demonstrated familiarity with Smartsheet or similar project tracking tools

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary for this role will range from $71,200 to $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.