Director, Credentialing (Hybrid - Los Angeles or Las Vegas)
Apply NowCompany: Astrana Health
Location: Monterey Park, CA 91754
Description:
Director, Credentialing (Hybrid - Los Angeles or Las Vegas)
Department: Ops - Credentialing
Employment Type: Full Time
Location: 1600 Corporate Center Dr., Monterey Park, CA 91754
Reporting To: Fahmida Musa
Description
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.
Our Values:
What You'll Do
Qualifications
Environmental Job Requirements and Working Conditions
Additional Information:
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin,
gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request accommodation.
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
Department: Ops - Credentialing
Employment Type: Full Time
Location: 1600 Corporate Center Dr., Monterey Park, CA 91754
Reporting To: Fahmida Musa
Description
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.
Our Values:
- Put Patients First
- Empower Entrepreneurial Provider and Care Teams
- Operate with Integrity & Excellence
- Be Innovative
- Work As One Team
What You'll Do
- 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.
Qualifications
- Bachelor's degree in healthcare administration, business, or related field required; Master's degree (MPH, MHA, MBA) preferred.
- Minimum of 7 years of progressive experience in provider credentialing within a healthcare organization, with at least 3 years in a leadership or management role.
- 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).
- Strong data management, documentation, and compliance tracking capabilities.
- 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 to senior leadership and supporting audit readiness.
Environmental Job Requirements and Working Conditions
- Our organization follows a hybrid work structure where the expectation is to work onsite 2 days per week. This position reports to our Monterey Park, CA or Las Vegas, NV office.
- The base salary target range is $140,000 to $150,000 annually. An annual target bonus and equity (RSU's) will be offered in addition to base compensation.
Additional Information:
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin,
gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request accommodation.
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.