Credentialing & Licensing Manager
Who You Are: You’re a credentialing expert who thinks strategically and executes with precision. You understand the complexities of NCQA credentialing and payor enrollment inside and out, and you’re excited by the opportunity to redesign and elevate how credentialing works at a fast-growing healthtech company. You thrive at the intersection of operations, technology, and compliance—and you’re energized by building scalable systems, not just maintaining them. You’re a natural collaborator who can work cross-functionally with Product and Operations teams while also leading and developing a team of your own. What you'll do: Strategic Leadership & Program Design Own the vision and roadmap for credentialing and licensing at Zivian, transforming the function from transactional to a strategic driver of provider success and organizational growth. Redesign and rebuild credentialing workflows end-to-end—identifying gaps, eliminating bottlenecks, and implementing scalable, best-in-class processes. Serve as Zivian’s internal subject matter expert on NCQA credentialing standards, payor enrollment requirements, and state licensing regulations. Partner closely with Product to shape and inform the credentialing and licensing features of Zivian’s software platform, translating operational needs into product requirements. Collaborate with the broader Operations team to ensure credentialing workflows integrate seamlessly with provider onboarding, engagement, and compliance processes. Credentialing & Licensing Operations Oversee end-to-end credentialing processes for providers, including initial credentialing, re-credentialing, and payor enrollment. Ensure compliance with NCQA guidelines, CMS requirements, state licensing regulations, and payor-specific credentialing standards. Manage and monitor expirable tracking for licenses, certifications, and accreditations—ensuring proactive renewals with no lapses. Maintain accurate, complete, and audit-ready credentialing files in compliance with HIPAA and applicable privacy regulations. Lead, manage, and develop a team of Licensing Specialists, fostering a high-performance culture rooted in quality, accountability, and continuous improvement. Build and maintain SOPs and process documentation to standardize credentialing operations across the team. Leverage credentialing systems and databases to ensure data integrity and generate reports for leadership and external stakeholders. Identify systemic process gaps and implement documented improvements to accelerate speed and reduce error rates. What You’ll Bring: 5+ years of experience in credentialing, medical staff services, or provider enrollment, with at least 2 years in a management or team lead role. Deep, hands-on knowledge of NCQA credentialing standards and payor credentialing/enrollment processes—this is a must. Proven ability to lead, develop, and hold accountable a team of credentialing professionals. A builder’s mindset: you’re not just here to maintain the status quo, but to redesign and improve how credentialing works. Strong cross-functional collaboration skills—you can work effectively with Product, Operations, and external stakeholders alike. Excellent organizational skills and ruthless attention to detail; you don’t let things fall through the cracks. Comfort with technology and credentialing systems; ability to quickly learn and adapt to new platforms. Strong written and verbal communication skills—you can translate complex regulatory requirements into clear, actionable guidance. Ability to balance strategic thinking with hands-on execution in a fast-paced, startup environment. Bachelor’s degree in Healthcare Administration, Business, or a related field preferred; CPCS or CPMSM certification a plus. Where You’ll Be: We offer flexibility in your work location! For this role, you just need to be based within the US, allowing you to work where you feel most productive. Our Core Values: Build with Intention: We stay focused on the work that matters most. No chasing shiny objects. We choose our priorities carefully and follow through with purpose and discipline. Trust and Be Trusted: We earn trust by being obsessed with our customers’ problems. We listen, we move fast, and we do what we say we’re going to do, every time. Lift as we climb: We show up for each other. We share context, lend a hand, and celebrate wins. When we lift the people around us, we elevate what’s possible for all of us. What Zivian Has for You: A dynamic, diverse, and collaborative work environment. Fast-paced startup culture full of growth-minded colleagues. A distributed team with opportunities for in-person collaboration. Employee equity pool. Competitive compensation and benefits package. A supportive, non-competitive work environment where the team truly cares about one another. Opportunities for continuous learning and professional growth. Flexibility in work location. At Zivian, we live by the value Trust and be Trusted. To protect the integrity of our team and the sensitive data of our healthcare partners, we maintain a rigorous verification process. Zivian participates in E-Verify and utilizes advanced background and identity validation tools for all candidates. Please note that providing fraudulent information or misrepresenting your identity at any stage of the application process is grounds for immediate disqualification. Apply To This Job