Clinica Sierra Vista is excited to be one of the largest Federally Qualified Health Centers in the Nation!
We're honored to serve the men and women of the fields. We also offer care and support to the inner city, the rural and isolated, those of low, moderate, and fixed incomes, and families from an array of cultural backgrounds who speak several languages. We don't inquire about immigration status because we simply don't need to know. If you come to us, we will treat you like any other patient.
As we grow our team, we are looking for individuals who believe the patient is always #1.
Why work for us?
Intrigued? We'd love to hear from you! Please review the job details below and then click "apply."
Position Summary:
The Associate Director is responsible for leading the credentialing and licensing functions to ensure all providers and facilities meet Joint Commission, HRSA, federal, state, and payer requirements. This role provides day-to-day operational oversight, sets priorities, ensures efficient resource utilization, maintains high performance standards, and drives process improvement to support organizational goals. The Associate Director partners with the Director of Human Resources and cross-functional leaders (including Compliance, Quality, Operations, and Provider Recruitment) to mitigate risk, maintain audit readiness, and deliver timely credentialing and licensing outcomes.
Essential Functions:
Facility Licensing:
Maintains working knowledge of licensing and credentialing requirements at the local, state, and Federal levels.
Applies for new business licenses, certifications, and registrations as required to support business operations.
Maintains regulatory business information such as Ownership, officers, Employer Identification Numbers, Medicare, and NPI Information.
Establishes and maintains tracking tools (e.g., SharePoint and Excel databases) and reporting to monitor licensure/registration status and compliance.
Oversees tracking of licensure expiration dates and verifies that professionally licensed individuals remain in good standing with the appropriate licensing entities.
Responsible for creating and tracking regulatory binders across lines of business.
Completes assigned compliance training and other educational programs as required.
Monitors the release of regulatory letters (e.g., DHCS, HRSA, CDPH) and routes them to appropriate leadership with recommended actions as needed.
Coordinate, prepare, and monitor special projects and reports as required.
Ensure that all CSV Clinics, CLIA, Pharmacy, Dispensary, and other operating licenses are current and renewed when due.
Gathering and verifying information, reviewing and gathering application requirements, and preparing and processing documents
Evaluating requests, approving invoices, and managing license administrators
Partners with Operations leadership to stay current on operational changes that impact licensing requirements and timelines.
Manage and evaluate all regulations and legislations for licensing activities, ensure proper implementation, and prepare strategies for various business groups.
Maintain information (license numbers, expiration dates, etc.) and obtain re-registration approvals before license expirations to ensure no disruption.
Reviewing applications for new licenses or renewals of existing licenses, making sure that all documentation is complete and accurate
Collaborate with internally and externally in prioritizing licensing projects.
Maintain and organize appropriate regulatory records to demonstrate compliance with applicable regulations.
Work closely with the compliance team to complete the audit and prepare the site for regulatory visits.
Understanding and interpretation of the state of California and federal health care regulations.
Knowledge of principles, practices, and techniques of current contract administration, preparation, and negotiation related to health care systems.
Knowledge of ethics, principles, and practices of contract administration.
Working knowledge of local, state, and Federal licensing requirements.
Credentialing:
Process Management - Initiates and follows through on all aspects of credentialing, including the initial and re-credentialing process for all practitioners and allied health staff employed and contracted with Clinica Sierra Vista. In addition, it initiates and follows through on all aspects of the privileging and re-privileging of physicians.
Initiates and conducts primary source verification of practitioner's background, education/training, and malpractice history through the use of online systems, written correspondence, telephone inquiries, and printed reference guides, rosters, and reports.
Identifies and evaluates potential red flags and partners with HR leadership, Compliance, and operational stakeholders to determine appropriate disposition and next steps.
Performs ongoing monthly and quarterly compliance reporting-analyzing report data and state board sanction information in support of ongoing monitoring requirements.
Is responsible for the preparation of materials and files for presentation and review by the credentialing committee.
Collaborates with inter-departmental peers, including Quality Management and Operations, to identify and implement best practices and ensure an integrated, timely, and consistent credentialing product.
Partners with Human Resources, Operations, and Provider Recruitment to ensure timely credentialing of new providers prior to start dates.
Recommends process and system improvements and maintains current knowledge of NCQA and Joint Commission requirements.
Ensures compliance with Joint Commission, NCQA standards, and other applicable regulatory agencies; supports development and maintenance of policies and procedures that govern credentialing operations.
Responsible for the accuracy and integrity of credentialing systems/data; leverages reporting and queries to support workflow prioritization and operational visibility.
Identifies and addresses issues proactively, ensuring timely, compliant resolution and clear documentation.
Demonstrates strong organizational skills and the ability to manage multiple priorities, including expedited credentialing requests when needed.
Ability to work cooperatively in a team environment to support and advance the mission, vision, and goals of Clinica Sierra Vista.
Builds collaborative working relationships to advance the mission, vision, and goals of Clinica Sierra Vista.
Submits completed credentialing applications to health plans for enrollment; tracks effective dates; and communicates enrollment status to Billing and other stakeholders.
Provides performance feedback, completes evaluations and competency documentation, and supports employee development to meet organizational and professional goals.
Maintains consistent, reliable, and on-site attendance as required by the position.
Team Leadership & Supervision:
Operational Oversight:
Collaboration & Communication:
Problem-Solving & Decision-Making:
Reporting & Analysis:
Qualifications:
Bachelor's degree preferred
Five years of credentialing experience in a managed care setting or experience in the medical field with a thorough understanding of credentialing, privileging, and licensing.
Proven ability to function independently with minimal direct supervision required.
Strong organizational and communication skills required.
Demonstrate organizational solid effectiveness and management leadership skills.
Proficient in Microsoft Office Suite (Outlook, Word, Excel).
Comfortable extracting and formatting data for ad hoc report requests.
Attention to detail is a must.
Confidentiality required.
Knowledge of MD Staff (ASM) preferred.
Significant working knowledge of accreditation standards, including Joint Commission, HRSA, CDC, HIPAA, NCQA, CMS and state and federal compliance standards.
Certification as Certified Provider Credentialing Special (CPCS).
Requirements:
Clinica Sierra Vista values human rights, goodwill, respect, inclusivity, equality, and recognizes that the organization derives its strength from a rich diversity of thoughts, ideas, and contributions. As leaders in healthcare industry, we aspire to be an employer of choice by promoting an organizational culture that reflects these core values. We seek to attract, develop, and retain a talented and dedicated workforce where people of diverse races, genders, religions, cultures, political affiliations and lifestyles thrive. Our goal is to create a welcoming and inclusive environment that empowers our employees to provide the highest level of service to our community of residents and businesses; they're counting on us.
Clinica Sierra Vista is an equal opportunity employer and strives to attract qualified applicants from all walks of life without regard to race, color, ethnicity, religion, national origin, age, sex, sexual orientation, gender identity, gender expression, marital status, ancestry, physical disability, mental disability, medical condition, genetic information, military and veteran status, or any other status protected under federal, state and/or local law. We aim to create an environment that celebrates and embraces the diversity of our workforce. We welcome you to join our team!