HSCSN Mgr Cred Prov Data Mgmt

The Credentialing and Provider Data Manager is responsible for overseeing all aspects of provider credentialing, recredentialing and the integrity of provider data within the health plan. This includes ensuring compliance with federal and state regulations, accreditation standards (e.g., NCQA, CMS, DOH), and contractual obligations. The role provides leadership for credentialing and provider data management operations, including process development, data quality, delegated oversight, provider data management, provider directory management and audit readiness. The Manager will also serve as the point of contact for credentialing-related audits and ensure timely, accurate updates to provider directories and databases. The Manager supervises the Provider Data Specialist and Credentialing Coordinators.

Minimum Education

Bachelor's Degree (Preferred)

Minimum Work Experience

• 7 years Credentialing experience (Required) And
• 5 years Supervisory or management experience (Required)

Required Skills/Knowledge

• Excellent written and verbal communication skills
• Strong presentation skills
• In-depth knowledge of health plan and medical staff credentialing practices
• Strong familiarity with accreditation standards and regulatory frameworks (e.g., NCQA, JC, AAAHC, CMS, DHCF)
• Proven ability to improve process efficiency and implement system automation
• Experience with credentialing software and provider data systems
• Ability to interpret documents, licenses, certifications, and accrediation standards
• Ability to manage multiple priorities in a fast-paced environment

Required Licenses and Certifications

Certified Provider Credentialing Specialist (CPCS) 1 Year (Required)

Job Functions

Organizational Accountabilities

Organizational Accountabilities (Managers)

Leadership Excellence

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Collaboration

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Leadership Skills

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Supervisory Responsibilities

Blood Borne Pathogen Exposure

Protected Health Information Access Level

Working Environment

Physical Requirements

Travel Requirements

This additional job description is currently unavailable. Please connect with your HR Business Partner to discuss.

The disclosed salary range includes the minimum and maximum rates within which Children’s National believes an individual’s base pay rate will fall for this position. It is not typical for an individual to be hired at or near the maximum of the pay range. The exact pay rate for this position will be based on a variety of factors in alignment with the Children’s National compensation philosophy. These factors are legitimate and non-discriminatory including, but not limited to, the current market conditions; organizational needs; the individual’s combination of prior work experience, level of education, knowledge, skills, and other qualifications. Children’s National is committed to providing a fair and competitive total rewards package to each of our employees. This base salary range does not include our comprehensive benefits package or any additional compensation for which this position may be eligible.

Childrens National Hospital is an equal opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender, identity, or other characteristics protected by law. The “Know Your Rights” poster is available here: and the pay transparency policy is available here: Know Your RightsPay Transparency Nondiscrimination Poster.

Please note that it is the policy of Children's National Hospital to ensure a “drug-free” work environment: a workplace free from the illegal use, possession or distribution of controlled substances (as defined in the Controlled Substances Act), or the misuse of legal substances, by all staff (management, employees and contractors). Though recreational and medical marijuana are now legal in the District of Columbia, Children's National and its affiliates maintain the right, in accordance with our policy, to enforce a drug-free workplace, including prohibiting recreational or prescribed marijuana.