Ncqa Jobs in California (NOW HIRING)

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Full Time US

Salary Range: $100,000.00 To $113,000.00 Annually

Senior Manager, Licensing and Credentialing At Author Health, we're revolutionizing how mental health care is delivered, and we want you to be part of it! Our mission is to bring compassionate, high-quality care to people with serious mental illness, substance use disorders, and dementia, including older adults.

We don't just treat symptoms. We treat people - fully, holistically, and with heart! Through our virtual-first, innovative care model, we deliver community-based wrap-around outpatient mental health care inclusive of psychiatric, psychotherapeutic and care management services. We partner with primary care providers, hospitals, families, and caregivers to keep patients out of the hospital and empower them to live healthier, more connected lives.

At Author, inclusivity isn’t a checkbox. It’s how we build trust and drive better outcomes! We honor the unique cultures, identities, and stories that shape every patient’s experience, and we’re creating a workplace where team members can show up as their full selves, too.

If you're driven by purpose, ready to shake up the status quo, and eager to make a real impact in people's lives, we'd love to meet you. Let's build the future of mental health care together! Summary & Objective

We are a fast-growing telehealth company seeking an experienced and strategic Senior Manager, Licensing and Credentialing. This role is responsible for overseeing all aspects of licensing and credentialing program including leading delegated credentialing and licensing — ensuring we meet regulatory requirements, maintain the highest standards of integrity, and credential clinicians on time to meet business goals.

The ideal candidate is a proactive problem-solver with deep expertise in licensing and payor credentialing operations, particularly in a telehealth or multi-state environment. You will serve as the primary point of contact for all licensing and credentialing matters, working closely with leadership, clinical teams, and vendors to build a scalable, reliable function.

Licensing & Credentialing: Develop and execute a proactive licensing and credentialing program that accounts for incoming clinician volume, target states, and payer panels — ensuring timely licensing and credentialing that meets business growth goals and launch timelines.

Delegated Credentialing: Own and manage the company's delegated credentialing function, ensuring compliance with NCQA standards and payer requirements across all applicable states.

Vendor Management: Serve as the primary relationship owner for all licensing and credentialing vendors — managing performance, accountability, and contract compliance.

Clinician Liaison: Act as the operational liaison between credentialing vendors and clinicians, facilitating clear communication, resolving bottlenecks, and ensuring a smooth clinician experience throughout the licensing and credentialing process.

Regulatory & Audit Compliance: Work with Compliance team on payor audits, OIG and SAM exclusion reporting for external vendors, and other regulatory filings. Ensure that our licensing and credentialing processes meet or exceed industry and regulatory standards

NCQA Certification: Lead the NCQA certification process to bring licensing and credentialing in-house, ensuring all requirements are met and documented.

Ongoing Maintenance: Proactively track and execute state license renewals, DEA registrations, and payer re-credentialing to prevent lapses in billing or practice status.

CAQH & Roster Management: Direct the creation, attestation, and maintenance of clinician CAQH profiles, and ensure the submission of accurate provider rosters to health plans.

System & Data Ownership: Serve as the primary business owner for the credentialing vendor platform, ensuring data integrity, secure document retention, and workflow automation.

Process Innovation & AI Utilization: Proactively identify opportunities to modernize licensing and credentialing workflows, leveraging AI, automation, or emerging technologies to reduce manual data entry, drive operational efficiency, and scale the function.

Reporting & KPIs: Establish and report on key performance indicators (KPIs) to executive leadership, such as credentialing turnaround times, application defect rates, and vendor SLA adherence.

Direct experience managing delegated credentialing programs, including NCQA standards, payer delegated agreements, and multi-state licensing requirements.

Forward-thinking and innovative mindset, with a proven track record of leveraging AI, automation, or continuous improvement methodologies to streamline complex operational workflows.

Proven ability to manage credentialing and licensing vendors, with experience holding vendors accountable to timelines and quality standards.

Experience hiring, leading and performance managing teams

Experience scaling licensing and credentialing functions in a startup or fast-growth healthcare or telehealth environment.

Operational fluency in clinical, care management, and data exchange processes common in value-based care or telehealth organizations.

Exceptional communication and influencing skills — able to work cross-functionally and advise both executive leadership and front-line clinical teams.

Strong project management skills with the ability to execute in a dynamic, ambiguous environment and drive multiple workstreams simultaneously.

5–7 years of experience in licensing and credentialing, preferably with a mental health or behavioral health provider.

3+ years of direct experience managing credentialing and/or licensing functions, including delegated credentialing programs.

Experience working with Medicare, Medicare Advantage, and Medicaid programs.

Experience in a telehealth or multi-state provider environment is strongly preferred.

Proficiency in credentialing and provider data management software; direct experience utilizing specific technology vendor s strongly preferred.

Bachelor's degree in a related field or equivalent experience required. Advanced degree or professional certifications (such as CPCS or CPMSM from NAMSS) are strongly preferred.

Bachelor's degree in a related field or equivalent experience required. Advanced degree or professional certifications strongly preferred

This is a fully remote position. Employees work from home using virtual tools and company-provided equipment to manage tasks, communicate with team members, clinicians, and stakeholders. The role requires sitting for extended periods in front of a computer screen and the ability to lift up to ten pounds.

Very limited.

Author Health is committed to a diverse and inclusive workplace. It is the company's policy to comply with all applicable equal employment opportunity laws by making all employment decisions without unlawful regard or consideration of any individual’s race, religion, ethnicity, color, sex, sexual orientation, gender identity or expressions, transgender status, sexual and other reproductive health decisions, marital status, age, national origin, genetic information, ancestry, citizenship, physical or mental disability, veteran or family status or any other basis protected by applicable national, federal, state, provincial or local law. The company’s policy prohibits unlawful discrimination based on any of these impermissible bases, as well as any bases or grounds protected by applicable law in each jurisdiction.

We are committed to providing an inclusive and accessible experience for all applicants. If you require any accommodations at any stage of the process, please let us know.

The company is pleased to provide such assistance and no applicant will be penalized as a result of such a request. In accordance with applicable legal requirements such as the San Francisco Fair Chance Ordinance Author Health will consider for employment qualified applicants with arrest and conviction records.

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