Credentialing & Provider Enrollment Program Manager, Yale Health

About the role

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.

Responsibilities

• 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.
• Maintains credentialing databases and systems, ensuring data integrity, accuracy, and alignment with workflows and reporting needs.
• Maintains credentialing databases and systems, ensuring data integrity, accuracy, and alignment with workflows and reporting needs.
• 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.
• Develop and maintain monitoring dashboards and ad-hoc reports with the YH Analytics team as appropriate.
• 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).

Requirements

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. 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. 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. 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. Well-developed organizational, planning, problem-solving, and communication skills, with attention to detail and the ability to multitask in a fast-paced environment. Advanced computer skills, including proficiency with Microsoft Office applications and the ability to learn new systems quickly. Ability to work independently and collaboratively in a highly regulated environment. Demonstrated a self-starter with the ability to work independently. High level of integrity, accountability, and professional judgment. Ability to ensure confidentiality, security and maintenance of sensitive information.

Qualifications

• Bachelor's degree in a related field and four years of related experience or an equivalent combination of education and experience.
• 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).