Senior Manager, Credentialing Operations

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. The Senior Manager, Credentialing Operations is the leader of critical functions within the Credentialing Verification Organization (CVO) and is accountable for the delivery of credentialing services, including production, quality, reporting, ongoing monitoring, and continuous process improvement. This role ensures the accuracy, integrity, and compliance of provider credentialing data across multiple lines of business, supporting the development and maintenance of a high-quality provider network. This leader plays a key role in advancing health plan objectives by driving operational excellence, regulatory compliance, quality outcomes, and provider experience. Through collaboration with cross-functional partners, the Senior Manager leverages data-driven insights, process optimization, and strategic execution to improve credentialing performance, enhance service delivery, and ensure timely, accurate credentialing decisions that support member access to care. Key Responsibilities • Leads a business services unit that delivers credentialing services in support of organizational objectives. • Establishes and communicates strategic direction for Credentialing Operations and ensures processes align with enterprise goals and priorities. • Analyzes operational performance metrics and key initiatives to evaluate progress against business objectives and identify opportunities for improvement. • Develops and implements strategies that enhance operational effectiveness, quality, compliance, and service delivery. • Serves as a trusted advisor to internal and external stakeholders on credentialing operations, business reviews, and related initiatives. • Leads audit activities, including issue identification, corrective action planning, error remediation, and rebuttal management. • Reviews audit findings for accuracy and provides guidance on issues with significant business or regulatory implications. • Partners with Network Management, Provider Relations, Provider Services, Health Delivery teams, and other cross-functional stakeholders to address provider-related issues and improve operational outcomes. • Drives continuous improvement initiatives that streamline processes, reduce risk, and enhance the provider and customer experience. • Fosters a culture of accountability, collaboration, innovation, and high performance.   Required Qualifications • Minimum of 5 years of experience in provider data management, provider network operations, provider relations, credentialing, or a related healthcare operations function. • Minimum of 3 years of experience leading and developing teams. • Experience working in credentialing operations. • Knowledge of and experience supporting Medicare, Medicaid, and/or Commercial Health Insurance lines of business. • Strong analytical, problem-solving, and decision-making skills. • Demonstrated ability to influence stakeholders and drive results across cross-functional teams. • Strong written and verbal communication skills. Preferred Qualifications • Experience leading operational transformation or continuous improvement initiatives. • Experience working within a Credentialing Verification Organization (CVO) environment. • Experience utilizing data and metrics to drive operational performance and business decisions. • Proven ability to manage multiple prior