Credentialing & Provider Enrollment Program Manager, Yale Health

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Overview
In 1971, Yale University established Yale Health to provide health services to its facility, staff and students through a multidisciplinary health maintenance organization located on campus. Yale Health has more than 50,000 members including students, staff, faculty and their families who come from every state in the country and almost every country in the world. With over 50 years of service to the Yale community, our state-of-the-art facility at 55 Lock Street, is where our members receive most of their care from our 150+ providers. It is a 144,000 square foot medical facility with over 90 exam rooms, an Acute Care Department, a 15-bed inpatient facility with two negative pressure rooms, a diagnostic imaging suite including MR and CT scan, x-ray and ultrasound and a full-service retail pharmacy.

The Credentialing & Provider Enrollment Program Manager at Yale Health Center, Health Management Organization (HMO) will own the credentialing, privileging and delegated credentialing program end-to-end — a complex, specialized area spanning provider onboarding, primary source verification, the internal credentialing committee, lead and conduct periodic audits, revise policies and procedures— while setting long-term credentialing strategy and managing the day-to-day function of the department. This role will partner cross-functionally with Compliance, Executive Leadership, Finance and Business Strategy, Human Resources and Operations to enhance provider credentialing and privileging, expand delegated statuses, resolve issues, and continuously improve the credentialing function. This is a hands-on leadership role and requires in-depth knowledge and experience managing a high-volume credentialing program. This position is ideal for a detailed oriented, data-driven, mid-level professional that is excited to both own the tactics and build the long-term strategy and promote a culture of compliance and accountability.

Responsibilities include:

• Collects, verifies and maintains provider and non-licensed professional’s credentials, including licensure, board certifications, training, and other required documentation.

• Own and operate the delegated credentialing program end-to-end, including provider onboarding, primary source verification, maintaining alignment with industry quality standards

• Establishes and maintains an effective means of communication internally and externally with clinical leaders, operational teams, regulatory entities and other sources in order to obtain required information for the Yale Health credentialing and privileging application processing.

• Maintains credentialing databases and systems, ensuring data integrity, accuracy, and alignment with workflows and reporting needs. Ensures alignment between regulatory requirements, credentialing processes, and system functionality (e.g., Workday Training, credentialing platforms).

• Monitors, tracks and reports on all provider licenses, certifications and registrations, ensuring continuous compliance and timely renewals. Escalates risk as appropriate.

• Supports the internal credentialing committee — presenting cases, maintaining meeting minutes, and managing approvals and denials.

• Manage internal audits to ensure ongoing credentialing quality and delegated credentialing compliance.

• Ensure regulatory readiness with ability to quickly pivot, escalating risks as appropriate

• Set and drive long-term credentialing strategy, partnering with Yale Medicine and Yale New Haven Health System, Human Resources and other central departments to expand delegated credentialing statuses

• Partner with Finance & Business Strategy to align on KPIs and incentive structure, to troubleshoot issues and credentialing-related denials

• Identify and implement process improvements that increase team efficiency, including automation and AI-enabled workflows in accordance with Yale University’s AI Governance guidelines

• Manage the transition of all paper-facing processes to the department’s contracted computer based-solution, leveraging technology to enhance departmental workflows, reduce errors, ensure timeliness and compliance

• Develop and maintain monitoring dashboards and ad-hoc reports with the YH Analytics team as appropriate

• Oversee day-to-day network provider enrollment across group and individual submissions, ensuring timely, accurate, and compliant applications tracked in the department’s contracted, web-based, electronic solution

Schedule/Shift: Full-time, 37.5 hours, generally M-F, 8:30 am – 5:00 p.m. Occasional early mornings, evenings, weekends, holidays/recess may also be required.

Site/Location: Full-Time Remote (required to be on-site quarterly or as need based of organizational needs)

Required Skills and Abilities

1. Demonstrated ability to manage staff and develop specific short- and long-term objectives for staff, with strong interpersonal skills to develop and lead a cohesive team.  Strong communication and presentation skills, with the ability to engage and influence stakeholders at all levels.

2.   Demonstrated experience in healthcare regulatory compliance, credentialing, privileging, and provider enrollment, with comprehensive knowledge of healthcare regulatory requirements, credentialing and privileging standards, and compliance frameworks.

3. Strong knowledge of relevant guidelines, regulations, and standards (e.g., Good Clinical Practice, IT policies, facilities management protocols).  Demonstrated ability to identify compliance risks and recommend practical, preventative solutions. 

4. Proven ability to handle complex issues with sound judgment, take initiative, and provide timely resolution.  Analytical and detail-oriented with the ability to manage multiple priorities and meet deadlines.

5. Well-developed organizational, planning, problem-solving, and communication skills, with attention to detail and the ability to multitask in a fast-paced environment.

6. Advanced computer skills, including proficiency with Microsoft Office applications and the ability to learn new systems quickly.

 7. Ability to work independently and collaboratively in a highly regulated environment.  Demonstrated a self-starter with the ability to work independently.

8. High level of integrity, accountability, and professional judgment.  Ability to ensure confidentiality, security and maintenance of sensitive information.

Preferred Skills and Abilities

Master’s Degree in related field or equivalent combination of education and experience, with minimum three years of experience.  Experience with Workday Training, VerityStream, or similar credentialing and compliance systems.  Experience working with regulatory/accrediting bodies (e.g., CMS, Joint Commission, state agencies, NCQA).

 

Principal Responsibilities

 

1. Oversees the advancement and growth of the program. Gives direction and leadership supporting the philosophy, mission, strategy, and annual goals and objectives. Assumes primary accountability for disseminating and publishing all program information to create public awareness and support of the program. 2. Works closely with leadership, internal and external colleagues, and community residents to further develop and implement strategic plans. 3. Identifies, solicits, and cultivates community partnerships and collaborations to assist in the development and growth of the program. Develops the metrics to identify and measure the success of the program. Responsible for measurements of grant success and related evaluation. 4. Assists in identifying and evaluating potential future funding sources, and contributes to the submission of grants and contracts supporting the program, including the annual submission and writing of all content areas and budgetary sections of grant applications. Develops and manages the program’s operating budget. 5. Develops the administrative infrastructure of the program. Manages human resource and administrative functions of the program, including staffing and hiring, supervision, performance development, counseling and discipline, if warranted. Oversees and manages information systems, facilities, and space needs. 6. Investigates, identifies, implements, and oversees the maintenance of systems to gather, track, and report information to support the initiatives of the program. Tracks all program activities and regularly informs leadership of progress on each initiative. Recommends structural or programmatic adjustments, changes or additions based on full knowledge of missions, goals, and objectives. 7. Initiates, designs, and manages the compilation of program communications; identifying outreach potential, and promoting philanthropic and collaborative support of the program. Contributes to the development and assists in the management of content on the program’s website and monitors all changes and additions to the editorial content. 8. May perform other duties as assigned. Required Education and Experience Bachelor's degree in a related field and four years of related experience or an equivalent combination of education and experience.

Job Posting Date

07/10/2026

Job Category

Professional

Bargaining Unit

NON

Compensation Grade

Administration & Operations

Compensation Grade Profile

Supervisor; Senior Associate (P5)

Salary Range

$68,000.00 - $120,500.00

Time Type

Full time

Duration Type

Staff

Work Model

Remote

Background Check Requirements

All candidates for employment will be subject to pre-employment background screening for this position, which may include motor vehicle, DOT certification, drug testing and credit checks based on the position description and job requirements. All offers are contingent upon the successful completion of the background check. For additional information on the background check requirements and process visit "Learn about background checks" under the Applicant Support Resources section of Careers on the It's Your Yale website.

Health Requirements

This role is a healthcare worker position. Healthcare workers (HCW) are defined as university employees working a healthcare setting who have the potential for direct or indirect exposure to patients, human research subjects or infectious materials including body substance, contaminated medical supplies, devices and equipment, surfaces, or air.  HCW have specific health requirements that must be met prior to starting work, including MMR vaccine or immunity, varicella (chickenpox) vaccine or immunity, TB screening, COVID vaccine according to University policy, hepatitis B vaccine or immunity, and annual flu vaccination.

Posting Disclaimer

Salary offers are determined by a candidate’s qualifications, experience, skills, and education in relation to the position requirements, along with the role’s grade profile and current internal and external market conditions.

The intent of this job description is to provide a representative summary of the essential functions that will be required of the position and should not be construed as a declaration of specific duties and responsibilities of the position. Employees will be assigned specific job-related duties through  their hiring department.

The University is committed to basing judgments concerning the admission, education, and employment of individuals upon their qualifications and abilities and seeks to attract to its faculty, staff, and student body qualified persons from a broad range of backgrounds and perspectives. In accordance with this policy and as delineated by federal and Connecticut law, Yale does not discriminate in admissions, educational programs, or employment against any individual on account of that individual’s sex, sexual orientation, gender identity or expression, race, color, national or ethnic origin, religion, age, disability, status as a special disabled veteran, veteran of the Vietnam era or other covered veteran.

Inquiries concerning Yale's Policy Against Discrimination and Harassment may be referred to the Office of Institutional Equity and Accessibility (OIEA).

Note

Yale University is a tobacco-free campus.