Manager, Credentialing - NCQA & Collaboration Services

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary The Manager, Credentialing Compliance & Collaboration Programs will play a critical role in ensuring ongoing alignment with NCQA credentialing standards while also overseeing a team responsible for the assignment and management of collaborating physicians and delegation agreements. In this role you will be dedicated to developing, managing, and monitoring NCQA-compliant processes, documentation, and readiness. You will also focus on leading the Collaboration Team, ensuring timely and compliant execution of physician assignments and agreement management across all participating states. Key Responsibilities NCQA Credentialing Compliance • Serve as the department’s subject matter expert on NCQA credentialing standards • Monitor and maintain compliance with NCQA credentialing and recredentialing requirements • Lead the development, updates, and implementation of NCQA-required policies, procedures, and quality improvement plans • Coordinate NCQA readiness activities including audits, file reviews, and delegation oversight • Conduct frequent NCQA mock reviews annually • Partner with quality, compliance, and audit teams to conduct internal reviews and implement corrective actions as needed • Educate and train internal stakeholders on NCQA standards and expectations • Ensure timely tracking and documentation of performance metrics required by NCQA Collaboration Team Oversight • Lead and support the Collaboration Team responsible for assigning collaborating physicians to nurse practitioners and physician assistants • Ensure timely and compliant execution of collaboration and delegation agreements • Manage physician roster capacity and track assignment trends to optimize alignment and efficiency • Manage the receipt of received state mandates and the implementation of actions to ensure compliance • Support communication and issue resolution between clinical partners and internal stakeholders • Ensure agreements meet legal and regulatory requirements for each state • Collaborate with Compliance and Legal to refine agreement templates and manage contract updates • Monitor and report on collaboration metrics and team productivity Basic Qualifications • Bachelor’s degree required; Master’s degree in healthcare administration, public health, or related field preferred • 3+ years of experience in healthcare credentialing, compliance, or NCQA-regulated environments. • 2+ years in a leadership or people management role. • Deep knowledge of NCQA credentialing standards and accreditation readiness processes • Experience with contract development and understanding of state-specific delegation requirements • Proven ability to lead cross-functional initiatives and drive performance through others • Excellent organizational, communication, and project management skills • High proficiency in Microsoft Office and credentialing software systems Preferred Qualifications • NCQA Surveyor or Certified Professional in Credentialing or Healthcare Quality (CPCS, • CPMSM, CPHQ) a plus. • Experience with multi-state provider networks and physician collaboration requirements. Work Environment Standard business hours with occasional need for extended hours during audits or major initiatives. Remote or hybrid work flexibility depending on organizational needs. Anticipated Weekly Hours 40 Time Type Full time Pay Range The Typical Pay Range For This Role Is $60,300.00 - $132,600.00 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. 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: • Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. • Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit We anticipate the application window for this opening will close on: 08/31/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Apply tot his job