Lead Director, Credentialing Operations

CVS Health • Hartford, CT • 1d ago

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Position Summary

The Lead Director, Credentialing Operations oversees the Credentialing Verification Organization (CVO) and is accountable for the overall delivery of credentialing services including production, quality audit, reporting, ongoing monitoring and process improvement for the business operation. Maintain and validate the credentialing data for all network providers for multiple lines of business. Ensure all provider information is accurately recorded and maintained to provide a compliant and quality network of providers who are treating Aetna members. Aligns policies and procedures for the Credentialing Operations department with organizational goals. Delivers on financial, operational, and service requirements while providing leadership and direction through multiple managers and vendors, by developing priorities and setting direction.

Key Responsibilities

-Oversee operational management of Commercial, Medicare, Medicaid credentialing operations, as well as ongoing monitoring of all providers.

-Manage a team of ~100 employees through multiple managers.

-Oversee on-shore and off-shore vendor support tied to business operations to align resources to support inventory management and provide oversight of partner performance through quality and timeliness initiatives.

-Contribute to planning and administration of company programs and initiatives that promote the Credentialing Operations agenda.

-Accountable for department initiatives and objectives in partnership with stakeholders and leadership.

Implement organizational policies, goals, and objectives based on best practices in the field.

-Build and develop strong functional operations management team through formal training, diverse assignments, coaching, communication, mentoring and performance management, and mentor team members to foster talent strategy and succession planning.

-Cultivate and manage relationships with various internal business partners.

-Ensure all Credentialing policies and procedures are executed consistently across the business operation and support alignment with accreditation agencies and regulatory bodies.

-Administer audit procedures for maintaining accurate and compliant provider credentialing data for contractual compliance, and network directory listing purposes.

-Experience with exploring solutions with automation, bots, AI, and other tools to drive exceptional performance in a highly visible operational environment.

-Create and deliver process improvement strategies to address internal trends and meet organizational vision and commitments on an ongoing basis.

-Drive change management through the organization to support competitive and changing environment.

-Lead integration and administration of credentialing databases, software, and other data sources and create strategies for continuous improvement.

Control resources to deliver financial results and objectives within established budget parameters.

Required Qualifications

7+ years directly related experience in Healthcare Operations with a production focus

Adept at execution and delivery (planning, delivering, and supporting) skills

Advance working knowledge of business systems, applications, and tools supporting credentialing, provider data and inventory management.

-Proven ability to work collaboratively at all levels.

-Ability to effect change.

-Exercises sound judgment and demonstrates analytical/data-driven decision-making skills.

Preferred Qualifications

-Experience in a matrixed environment which includes outsourcing to external vendors.

-Project management experience.

Education

Bachelor's degree or equivalent work experience

Pay Range

The typical pay range for this role is:

$100,000.00 - $231,540.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments (https://learn.bswift.com/cvshealth-mainland) .

We anticipate the application window for this opening will close on: 08/15/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran - committed to diversity in the workplace.

Similar Jobs

Engineer, Application and Development, Warehouse Transformation

Cardinal Health • Hartford, CT • 3h ago

IT & Engineering

What Application Development & Maintenance contributes to Cardinal Health Information Technology oversees the effective development, delivery, and operation of computing and information services. This function antici...

3h ago

Go to Apply

Customer Service Manager (Enterprise Financial)

Brink's • Hartford, CT • 3h ago

Finance, Accounting & Banking

About Brink's: The Brink's Company (NYSE:BCO) is a leading global provider of cash and valuables management, digital retail solutions, and ATM managed services. Our customers include financial institutions, retailers, go...

3h ago

Go to Apply

Insurance Customer Service Representative

Kelly Services • Avon, CT • 3h ago

Finance, Accounting & Banking

Job searching is a lot better with someone in your corner. Kelly® Professional & Industrial is seeking a Customer Service Representative to work at a leading organization in Avon, CT . Sound like something you're int...

3h ago

Go to Apply

Sales & Use Tax Manager

Teradata • Hartford, CT • 5h ago

Finance, Accounting & Banking

Our company At Teradata, we believe that people thrive when empowered with better information. Teradata Autonomous Knowledge Platform activates enterprise intelligence by unifying data, knowledge and business @context to...

5h ago

Go to Apply

Territory Sales Manager - Oncology (Cleveland, OH)

Sumitomo Pharma • Hartford, CT • 5h ago

Management & Administrative

Sumitomo Pharma Co., Ltd., is a global pharmaceutical company based in Japan with operations in the U.S. (Sumitomo Pharma America, Inc.), focused on addressing patient needs in oncology, urology, women's health, rare dis...

5h ago

Go to Apply

Retail Sales Associate - Part Time

Burlington • Farmington, CT • 6h ago

Retail & Hospitality

If you want an exciting job with one of the largest off-price retail stores in the nation, join the Burlington Stores, Inc. as a Retail Sales Associate! Are you an outgoing, upbeat, people-person with great organizationa...

6h ago

Go to Apply

Tech Consulting - FinTech - AI Finance - Senior

EY • Hartford, CT • 6h ago

Finance, Accounting & Banking

Location: Anywhere in Country At EY, we're all in to shape your future with confidence. We'll help you succeed in a globally connected powerhouse of diverse teams and take your career wherever you want it to go. Join EY...

6h ago

Go to Apply

Actuarial Analyst II

Elevance Health • Wallingford, CT • 6h ago

Actuarial Analyst II Location: This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This ap...

6h ago

Go to Apply

Adobe Edge Delivery Services Solution Architect

Accenture • Hartford, CT • 6h ago

Retail & Hospitality

We Are: Accenture Adobe Business Group. What Accenture does best is UNLEASH the powers of emotion, empathy, and excitement at an enterprise scale to create the best experiences on the planet- for our clients and their cu...

6h ago

Go to Apply

Adobe Edge Delivery Services Engineer

Accenture • Hartford, CT • 7h ago

Retail & Hospitality

7h ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)