Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.Why Join Us?- Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
- Family Comes First: Total rewards package that promotes the idea of family first for all employees. Paid vacation and sick leave with paid maternity and paternity available immediately upon hire
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Benefits & Perks- Base compensation is only one component of your competitive Total Rewards package
- Incentive pay program (EPIP)
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- 401(k) plan matching up to 5%
- Tuition reimbursement
- Health & fitness benefits, discounts and resources
Job SummaryUnder the direction of the Director, Provider Network Solutions Operations, the Manager, Credentialing is responsible for leading BCBSKS credentialing and recredentialing operations, accreditation compliance, delegated credentialing oversight, provider enrollment readiness, and quality assurance activities for professional and institutional provider networks. This position provides strategic and operational leadership to ensure compliance with NCQA, URAC, CMS, state and federal regulations, and delegated contractual requirements while promoting provider experience, operational excellence, and member access to care. The Manager establishes department goals, develops staff, drives continuous improvement, oversees audit and compliance performance, and collaborates across the enterprise to ensure accurate, timely, and compliant credentialing outcomes that support BCBSKS business objectives and regulatory obligations.
Work LocationThis position is eligible to work hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.
What you'll do- Lead all credentialing and recredentialing operations for professional and institutional provider networks, ensuring timely, accurate, and compliant outcomes.
- Establish and execute the credentialing strategy, goals, performance metrics, and priorities aligned with BCBSKS business objectives.
- Ensure compliance with NCQA, URAC, CMS, state and federal regulations, corporate policies, and accreditation standards.
- Direct oversight of delegated credentialing arrangements, including monitoring, auditing, and corrective action management.
- Lead, develop, and manage team performance through coaching, training, succession planning, accountability, and employee engagement.
- Establish quality assurance programs and internal controls to ensure credentialing data integrity, accuracy, and audit readiness.
- Serve as the credentialing subject matter expert and primary resource for providers, leadership, internal business partners, and external stakeholders.
- Partner with connected enterprise business areas to support provider network operations and regulatory requirements.
- Oversee Corporate Credentialing Committee readiness, provider case review processes, and reporting activities.
- Drive continuous improvement through process optimization, technology adoption, workflow redesign, and data-informed decision making.
- Monitor operational, compliance, accreditation, and provider network risks and implement mitigation strategies to protect organizational interests.
- Maintain accountability for departmental performance, resource management.
What you'll need
Education- High school diploma or equivalent required
- Bachelor's degree or equivalent in healthcare administration, business administration, human relations, or related field preferred
- In lieu of degree, an additional 3 years of relevant experience required
Experience- Minimum 5 years' experience in the healthcare industry with direct credentialing responsibility required
- Minimum 3 yearsBBTECH