Credentialing Manager in Orange at Prospect Medical Systems

Date Posted: 11/13/2019

Job Snapshot

  • Employee Type:
  • Location:
    600 City Parkway West
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
  • Job ID:

Job Description

Credentialing Manager

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The Credentialing Department provides Credentialing and practitioner data management services for practitioners affiliated with Prospect Medical. This position directs and supervises the operation of the Credentialing Department including, but not limited to, the planning and development of activities/procedures to assure compliance with NCQA, CMS, DHS, and health plan credentialing requirements. Also responsible for ensuring the accuracy of practitioner data in both internal databases and health plan directories.

Job Responsibilities/Duties​

  • Responsible for credentialing activities and supervision of credentialing process.
  • Oversees, develops, and maintains database programs for credentialing.
  • Responsible for/assures reappointment process is initiated for each practitioner.
  • Responsible for initial recommendations regarding bylaw revisions, deletions, additions.
  • Summarize statistics and committee minutes for monthly reports to Board of Directors.
  • Plan, develop, and coordinate activities/procedures to assure compliance with NCQA, CMS, DHHS, and health plan requirements.
  • Coordinate credentialing audits.
  • Oversees for the submission of provider credentialing information to health plans for inclusion in Prospect networks.
  • Direct all Credentialing Department administrative functions.
  • Oversee and coordinate credentialing activities with contracted CVO.​


Minimum Education:  Bachelors in Business Administration or equivalent from a four year college or technical school; or five years experience and/or training in credentialing and/or contracting in a hospital or IPA setting; or equivalent combination of education and experience. .

Minimum Experience:  Three to five (3-5) years’ experience leading a team.  Proficient in Micro-Med, spreadsheet and word processing software. Knowledge of NCQA, CMS, and Health Plan Standards. Knowledge of state and other regulatory requirements for credentialing

Req. Certification/Licensure:  CMSC or CPCS Certification preferred.

Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance

Prospect Medical Systems has a zero-tolerance policy regarding the use of drugs and alcohol.  Our Company is committed to maintaining a productive, drug free workplace that keeps employees and patients safe from harm.  For this reason, we require applicants to pass a screening for drug use as a condition of employment.  This includes: alcohol, marijuana, cocaine, opiates and methamphetamines.

How to Apply

To apply for this role, or search our other openings, please visit  and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

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Keywords: Acute Care