Director of Provider Relations and Credentialing

Job Description:

Director of Provider Relations and Credentialing

Description

The Position

Bargaining Unit: Local 21 - Supervisory Management

Why Join Contra Costa Health Services?
Contra Costa Health Plan (CCHP) is offering an exciting opportunity for a Director of Provider Relations and Credentialing. This role, based in Martinez, CA, will lead the Provider Relations and Credentialing Department, part of Contra Costa Health Plan. CCHP is a managed care program serving Contra Costa County, providing health coverage to Medi-Cal recipients, county employees, and in-home support services (IHSS) workers. A Medicare Dual Special Needs Plan (D-SNP) will also launch in January 2026.

The Director will oversee strategic development, direction, and implementation of the provider network strategies to support Medi-Cal and D-SNP growth and performance. This Director role ensures a robust, high performing compliant provider network is maintained to provide access and quality care to our health plan members. The Director of Provider Relations and Credentialing will have responsibility for Provider Relations, Network Development & Contracting, Credentialing and Network Management.
Key qualities we are looking for:

• Leadership: Demonstrates ability to set direction, motivate teams, drive performance while fostering accountability and collaboration across departments

• A self-starter: Ability to work independently and as part of a team
• A skilled planner: Strong ability to analyze, organize, and prioritize tasks
• Organized: Capable of managing multiple responsibilities.
• Composed: Able to perform under pressure with good judgment.

What you will typically be responsible for:
Operations:

• Collaborating on cross-functional projects, focusing on network management
• Leading provider relations initiatives and provider training programs including but not limited to participation in provider townhalls and educational events
• Overseeing operations and collaborating with IT partners to ensure accurate and timely updates to provider data, provider rosters and directories
• Providing leadership on special projects related to network management, network development, contracting, credentialing, and provider relations
• Creating and maintaining efficient operational process and standard operating procedures for key functions of the Provider Relations and Credentialing Department

Strategy:

• Developing network strategies that support business goals, including expansion of D-SNP line of business
• Developing and prioritizing field staff projects and mentoring efforts
• Developing and overseeing a provider engagement strategy that supports satisfaction, retention, and performance
• Contributing to CCHP's population health management, quality and risk adjustment objectives as it relates to provider network and contracting strategies for improved performance to include but not limited to value-based contacts, pay for performance programs

Contracting:

• Overseeing contract negotiations and contacting strategies for physicians, health systems, hospitals, and ancillary providers
• Driving complex contract negotiations with key high profile health systems and providers
• Providing expertise in provider compensation models including fee for service, capitation, DRGs for Medi-Cal and Medicare.

Provider Relations/Engagement:

• Fostering strong relationships with providers through regular communication and issue resolution
• Ensuring providers are informed and educated about health plan operations, policies, programs and regulatory requirements
• Managing escalated complaints, ensuring timely resolution
• Leading Joint Operation Meetings (JOMs) with provider groups to address issues
• Developing tools and policies to enhance provider satisfaction and performance

Credentialing:

• Ensuring credentialing operations meets all federal, state and accreditation standards, including Centers for Medicare & Medicaid (CMS), National Committee for Quality Assurance (NCQA) and state Medi-Cal regulatory requirements
• Leading and managing end to end process for initial credentialing and recredentialing of network providers
• Developing and implementing policies and procedures that ensure compliance with NCQA, CMS and Department of Health Care Services (DHCS) requirements
• Managing and monitoring delegated credentialing entities

Regulatory:

• Monitoring and maintaining compliance of regulatory for network access to care and adequacy
• Ensuring compliance with regulatory agencies and accreditation standards
• Collaborating on audits, implement corrective actions as needed
• Responding to regulatory requests and assisting with required surveys and reports

Talent Management:

• Recruiting and retaining diverse talent that reflects the community we serve
• Fostering a culturally inclusive, collaborative work environment
• Leading employee training, development, and performance management

• Monitoring compliance with mandatory requirements and licensure standards

A few reasons you might love this job:

• You will work with a small, supportive team where flexibility and collaboration are key
• You will have the opportunity to influence policy and strategy alongside CCHP leadership
• You will be challenged and rewarded with professional growth opportunities

A few challenges you might face in this job:

• Your day-to-day tasks may shift based on unit priorities
• You will be expected to step in during employee leaves or vacations
• You will lead multiple projects with competing deadlines

Competencies Required:

• Delivering Results: Meeting organizational goals and customer expectations and making decisions that produce high-quality results by applying technical knowledge, analyzing problems, and calculating risks
• Innovative Problem Solving: Identifying and analyzing problems in order to propose new ways to do business
• Legal & Regulatory Navigation: Understanding, interpreting, and ensuring compliance with laws and regulations
• Adaptability: Responding positively to change and modifying behavior as the situation requires
• Building & Maintaining Relationships: Establishing rapport and maintaining mutually productive relationships
• Teamwork: Collaborating with others to achieve shared goals
• Political & Organizational Savvy: Working skillfully with politics, procedures, and protocols across organizational levels and boundaries

Read the complete job description by clicking this link.

The eligible list established from this recruitment may remain in effect for six months.

Minimum Qualifications

Education: Possession of a Bachelor’s Degree from an accredited college or university with a major in Business Administration, Public Administration, Hospital or Health Care Administration, Public Health Administration, or a closely related field.

Experience: Three (3) years of Full-Time, or its equivalent, experience in an administrative capacity in either a health services agency, health plan, or program performing member and/or provider grievance management or developing member and/or provider communication media. At least one (1) year of the required experience must have been in a supervisory capacity.

Substitution: Possession of a Master’s Degree in Business Administration, Public Administration, Hospital or Health Care Administration, Public Health Administration, or a closely related field may be substituted for one (1) year of the required experience. No substitution is allowed for the required supervisory experience.

Selection Process

1. Application Filing and Evaluation: Applicants will be required to complete a supplemental questionnaire at the time of application, applications will be evaluated to determine which candidates will move forward in the next phase of the recruitment process.
2. Behavioral Consistency Questionnaire (BCQ) Assessmen t: Candidates who possess the minimum qualifications will be invited to participate in an online assessment. The online assessment will measure candidates' competencies as they relate to the job and candidates must achieve an average passing score of 70% or higher on each of the competencies, as well as an overall passing score of 70% or higher. These competencies may include but are not limited to: Critical Thinking, Decision Making, Action & Results Focused (taking the initiative), Leadership, and Project Management. (Weighted 100%)

The BCQ is tentatively scheduled to take place via computer May 7-11, 2025.

The Human Resources Department may change the examination steps noted above in accordance with the Personnel Management Regulations and accepted selection practices.

For recruitment questions, please contact Exams@cchealth.org . For any technical issues, please contact the GovernmentJobs' applicant support team for assistance at +1 855-524-5627.

CONVICTION HISTORY

After you receive a conditional job offer, you will be fingerprinted, and your fingerprints will be sent to the California Department of Justice (DOJ) and the Federal Bureau of Investigation (FBI). The resulting report of your conviction history (if any) will be used to determine whether the nature of your conviction conflicts with the specific duties and responsibilities of the job for which you have received a conditional job offer. If a conflict exists, you will be asked to present any evidence of rehabilitation that may mitigate the conflict, except when federal or state regulations bar employment in specific circumstances. Having a conviction history does not automatically preclude you from a job with Contra Costa County. If you accept a conditional job offer, the Human Resources department will contact you to schedule a fingerprinting appointment.

DISASTER SERVICE WORKER

All Contra Costa County employees are designated Disaster Service Workers through state and local law. Employment with the County requires the affirmation of a loyalty oath to this effect. Employees are required to complete all Disaster Service Worker-related training as assigned, and to return to work as ordered in the event of an emergency.

EQUAL EMPLOYMENT OPPORTUNITY

It is the policy of Contra Costa County to consider all applicants for employment without regard to race, color, religion, sex, national origin, ethnicity, age, disability, sexual orientation, gender, gender identity, gender expression, marital status, ancestry, medical condition, genetic information, military or veteran status, or other protected category under the law.

To find more information on Benefits offered by Contra Costa County, please go to https://www.contracosta.ca.gov/1343/Employee-Benefits

Closing Date/Time: 4/25/2025 11:59 PM Pacific

Salary:

$132,375.86 - $160,903.64 Annually