Director of Credentialing

The mission of The Los Angeles Cancer Network is to provide unparalleled care to each patient that comes through our doors. We offer individualized treatment using the most recent and relevant proven advances in cancer care, curated with deliberation and compassion. LACN is committed to educating and supporting our patients and their families through every step of the way. We deliver a unique approach for every patient to ensure they receive treatment best suited to their condition, age, and other important factors. We do this by participating in important clinical research, encouraging screenings for early detection, and providing innovative treatment. We are proud to be at the forefront of cancer research through our partnership with OneOncology.

Why Join Us? We are looking for talented and highly-motivated individuals who demonstrate a natural desire to support the meaningful work of community oncologists and the patients we serve.

Job Description:

Job Summary:

We are seeking a strategic and detail-oriented Director of Credentialing to lead and manage provider credentialing and recredentialing processes across our growing network. This individual will ensure compliance with NCQA, CMS, and state-specific regulatory requirements while supporting rapid provider onboarding in a managed care environment.

Essential Functions:

The following reflects management's definition of essential functions for this job but does not restrict the tasks that may be assigned. Management may assign or reassign duties and responsibilities to this job at any time with reasonable accommodations.

• Oversee end-to-end credentialing and recredentialing for all contracted providers and facilities.
• Maintain compliance with regulatory and accreditation standards (e.g., NCQA, CMS, state DMHC/DOH).
• Partner cross-functionally with Provider Relations, Compliance, Payer Contracting, and Clinical Ops to streamline processes and support network growth.
• Lead and manage credentialing team operations, including performance management and process improvement initiatives.
• Manage credentialing software and data integrity across systems.
• Prepare for and lead credentialing audits, both internal and external.
• Serve as the subject matter expert on credentialing best practices, ensuring timely, accurate, and efficient operations.
• Compile, submit and track credentialing/re-credentialing applications for all providers. Ensuring all new providers as well as existing providers are properly credentialed.
• Responsible for tracking and renewing each provider's license, certifications, malpractice insurance and DEA to ensure timely renewals.
• Review applications for completion, accuracy and timely submission. Follow-up appropriately per internal documented guidelines.
• Track and maintain participation with all health plans including but not limited to managed care plans along with hospitals ensuring providers have appropriate hospital privileges.
• Track continuing education credits notifying providers of deficiencies.
• Maintain up-to-date and accurate credentialing status and documentation for each provider in electronic (credentialing database) and hard copy format.
• Communicate with providers all documents required for credentialing, re-credentialing, license/certification renewals, etc. always following provider notification documented timelines.
• Communicate provider credentialing status internally including new providers as they become participating with each payer.
• Ensure all office location additions and/or changes are appropriately handled by notifying health care plans for a seamless transition.
• Credential new modalities/lines of business to prevent disruption to reimbursement. Provide status updates to management team.
• Notify health plans, hospitals, etc. of provider terminations and name changes.
• Assist internal departments to resolve payer issues regarding system errors, non-par status and other issues.
• Maintain knowledge of current health plan requirements for credentialing providers recognizing the latest standards and procedures in credentialing and accreditation
• Inform Director and/or Medical Director of potential credentialing, hospital privilege and non-compliance issues.
• Work with leadership to develop/implement resolutions.
• Assist with developing and maintaining team Policy and Procedures, staff communication and ongoing team training and education.

Key Competencies:

• Excellent communication skills.
• Strong analytical, strategic planning, and problem-solving skills.
• Ability to function as an effective team leader.

• Demonstrated success in leading high-performing teams and implementing process improvements in credentialing operations.
• Strong interpersonal and communication skills, with the ability to work collaboratively across clinical, legal, and operational teams.
• Experience presenting senior leadership and supporting audit readiness.

Education and Experience:

• Bachelor's degree in a medical, business, or related field, or an equivalent combination of relevant education and experience. Master's Degree Preferred.
• At least ten (10) years of experience as a medical staff manager or director or a similar position in the medical field preferred and at least five (5) years' experience in payer credentialing
• CPCS, CRCM, CCEP or CPMSM certified, highly preferred.
• Deep understanding of federal and state regulatory requirements including NCQA, CMS, and state-specific guidelines.
• Proven experience with delegated credentialing agreements and payer enrollment processes.
• Familiarity with managed care operations, value-based care models, and MSO structures.
• Proficiency in credentialing software platforms (e.g., CAQH, Echo, Modio, or similar).
• Previous Oncology/Hematology experience preferred.

Additional Requirements:

• Great Customer Service Skills.
• Knowledge of medical terminology, specifically in Oncology/Hematology.
• Able to travel to satellite clinics when necessary.
• Must be willing and able to lift up to 25 pounds.

Salary Transparency:

Exact compensation may vary based on skills, education, certifications, experience, and location. Base Salary Range from $120,000.00 to $130,000.00