Associate Director, Licensing & Credentialing at Clinica Sierra Vista

Bakersfield, California, United States -

Full Time

Start Date

Immediate

Expiry Date

23 Jul, 26

Salary

136052.8

Posted On

24 Apr, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Credentialing, Licensing, Regulatory Compliance, Joint Commission Standards, NCQA Standards, HRSA Requirements, Provider Enrollment, Audit Readiness, Team Leadership, Process Improvement, Data Analysis, Contract Administration, Healthcare Regulations, Microsoft Office Suite, MD Staff, CPCS

Industry

Hospitals and Health Care

Description

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: 1. Maintains working knowledge of licensing and credentialing requirements at the local, state, and Federal levels. 2. Applies for new business licenses, certifications, and registrations as required to support business operations. 3. Maintains regulatory business information such as Ownership, officers, Employer Identification Numbers, Medicare, and NPI Information. 4. Establishes and maintains tracking tools (e.g., SharePoint and Excel databases) and reporting to monitor licensure/registration status and compliance. 5. Oversees tracking of licensure expiration dates and verifies that professionally licensed individuals remain in good standing with the appropriate licensing entities. 6. Responsible for creating and tracking regulatory binders across lines of business. 7. Completes assigned compliance training and other educational programs as required. 8. Monitors the release of regulatory letters (e.g., DHCS, HRSA, CDPH) and routes them to appropriate leadership with recommended actions as needed. 9. Coordinate, prepare, and monitor special projects and reports as required. 10. Ensure that all CSV Clinics, CLIA, Pharmacy, Dispensary, and other operating licenses are current and renewed when due. 11. Gathering and verifying information, reviewing and gathering application requirements, and preparing and processing documents 12. Evaluating requests, approving invoices, and managing license administrators 13. Partners with Operations leadership to stay current on operational changes that impact licensing requirements and timelines. 14. Manage and evaluate all regulations and legislations for licensing activities, ensure proper implementation, and prepare strategies for various business groups. 15. Maintain information (license numbers, expiration dates, etc.) and obtain re-registration approvals before license expirations to ensure no disruption. 16. Reviewing applications for new licenses or renewals of existing licenses, making sure that all documentation is complete and accurate 17. Collaborate with internally and externally in prioritizing licensing projects. 18. Maintain and organize appropriate regulatory records to demonstrate compliance with applicable regulations. 19. Work closely with the compliance team to complete the audit and prepare the site for regulatory visits. 20. Understanding and interpretation of the state of California and federal health care regulations. 21. Knowledge of principles, practices, and techniques of current contract administration, preparation, and negotiation related to health care systems. 22. Knowledge of ethics, principles, and practices of contract administration. 23. Working knowledge of local, state, and Federal licensing requirements. Credentialing: 1. 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. 2. 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. 3. Identifies and evaluates potential red flags and partners with HR leadership, Compliance, and operational stakeholders to determine appropriate disposition and next steps. 4. Performs ongoing monthly and quarterly compliance reporting—analyzing report data and state board sanction information in support of ongoing monitoring requirements. 5. Is responsible for the preparation of materials and files for presentation and review by the credentialing committee. 6. 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. 7. Partners with Human Resources, Operations, and Provider Recruitment to ensure timely credentialing of new providers prior to start dates. 8. Recommends process and system improvements and maintains current knowledge of NCQA and Joint Commission requirements. 9. Ensures compliance with Joint Commission, NCQA standards, and other applicable regulatory agencies; supports development and maintenance of policies and procedures that govern credentialing operations. 10. Responsible for the accuracy and integrity of credentialing systems/data; leverages reporting and queries to support workflow prioritization and operational visibility. 11. Identifies and addresses issues proactively, ensuring timely, compliant resolution and clear documentation. 12. Demonstrates strong organizational skills and the ability to manage multiple priorities, including expedited credentialing requests when needed. 3. Ability to work cooperatively in a team environment to support and advance the mission, vision, and goals of Clinica Sierra Vista. 13. Builds collaborative working relationships to advance the mission, vision, and goals of Clinica Sierra Vista. 14. Submits completed credentialing applications to health plans for enrollment; tracks effective dates; and communicates enrollment status to Billing and other stakeholders. 15. Provides performance feedback, completes evaluations and competency documentation, and supports employee development to meet organizational and professional goals. 16. Maintains consistent, reliable, and on-site attendance as required by the position. Team Leadership & Supervision: · Lead, mentor, and develop the licensing and credentialing team; set clear expectations, priorities, and service standards. · Establish performance goals and accountability; provide coaching, feedback, and formal performance evaluations. · Ensure appropriate staffing, training, and tools are in place to meet established timelines, quality standards, and audit-readiness expectations. · Ensure team adherence to organizational policies, regulatory requirements, and applicable employment laws. · Communicate status, risks, and priorities to leaders and stakeholders; escalate issues appropriately with clear recommendations. · Drive a culture of service excellence, continuous improvement, and compliance across the team. · Partner with cross-functional teams to resolve complex issues, standardize workflows, and improve end-to-end credentialing and licensing outcomes. Operational Oversight: · Oversee day-to-day operations for licensing and credentialing, ensuring work is completed on time, accurately, and in alignment with organizational policy and regulatory requirements. · Define, monitor, and report key performance indicators (KPIs) and service level expectations (SLAs) for credentialing, enrollment, and licensing deliverables. · Lead continuous-improvement efforts (process, controls, and systems) to improve cycle time, reduce risk, and increase stakeholder satisfaction. Collaboration & Communication: · Build strong partnerships across departments to align priorities, clarify requirements, and ensure timely, compliant licensing and credentialing outcomes. · Serve as a primary point of contact for leadership on credentialing/licensing status, risks, and remediation plans. · Coordinate with functional leaders to standardize processes, improve handoffs, and ensure consistent application of requirements across the organization. Problem-Solving & Decision-Making: · Resolve complex operational and personnel issues using sound judgment, policy, and regulatory requirements. · Make decisions that balance compliance, operational efficiency, and business needs; document rationale and ensure appropriate escalation. · Address internal stakeholder concerns related to credentialing, enrollment, and licensing, ensuring timely resolution consistent with organizational expectations. · Lead key initiatives from planning through execution (e.g., payer onboarding, system changes, audit remediation), ensuring alignment to timelines, quality standards, and desired outcomes. · Allocate resources effectively and adjust priorities to meet commitments and minimize compliance and operational risk. · Track progress, remove barriers, and implement corrective actions to keep work on schedule and in compliance. Reporting & Analysis: · Develop and deliver regular operational reporting to leadership (e.g., volumes, cycle times, aging, audit readiness, and risk items) with recommended actions. · Analyze trends to identify root causes, improvement opportunities, and emerging compliance risks; drive mitigation plans. · Maintain accurate documentation and controls to support internal audits, external surveys, and regulatory reviews. · Other duties as assigned or based on the needs of the organization. Qualifications: 1. Bachelor’s degree preferred 2. 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. 3. Proven ability to function independently with minimal direct supervision required. 4. Strong organizational and communication skills required. 5. Demonstrate organizational solid effectiveness and management leadership skills. 6. Proficient in Microsoft Office Suite (Outlook, Word, Excel). 7. Comfortable extracting and formatting data for ad hoc report requests. 8. Attention to detail is a must. 9. Confidentiality required. 10. Knowledge of MD Staff (ASM) preferred. 11. Significant working knowledge of accreditation standards, including Joint Commission, HRSA, CDC, HIPAA, NCQA, CMS and state and federal compliance standards. 12. Certification as Certified Provider Credentialing Special (CPCS). Requirements: · Must be able to work a full-time schedule. · Must be able to pass all pre-employment screening (background check, drug tests, and references). · Must be able to comply with organizational behavioral standards. Physical Requirements: Bending/Twisting 5% Walking 5 % Sitting 70% Push/Pulling 2% Reaching Overhead 2 %

Responsibilities

The Associate Director leads the credentialing and licensing functions to ensure providers and facilities meet all regulatory and payer requirements. This role provides operational oversight, drives process improvements, and manages cross-functional collaboration to maintain audit readiness and organizational compliance.