Description Key Responsibilities: Credentialing and Verification: Oversee and facilitate the initial credentialing and recredentialing process for healthcare providers participating in managed care networks. Verify licenses, certifications, education, training, and work history following California state regulations. Ensure compliance with National Committee for Quality Assurance (NCQA), Centers for Medicare & Medicaid Services (CMS), The Joint Commission (TJC), and California-specific guidelines. Knowledge of Managed Care Requirements: Maintain up-to-date understanding of managed care policies, contracts, and credentialing requirements specific to California. Work with Managed Care Organizations (MCOs) to ensure timely processing and compliance with Medicaid and Medicare standards. Regulatory and Compliance Adherence: Monitor compliance with California-specific licensing and credentialing laws, including Medical Board regulations and Department of Managed Health Care guidelines (Source: SG25 US Healthcare.docx). Track accrediting standards and proactively manage required provider information updates for compliance audits or inspections. Data Management and Record Keeping: Maintain accurate databases for provider credentialing files, including updates to California-specific licensing expiration dates. Regularly audit credentialing documentation to ensure accuracy and meet managed care specifications. Communication and Collaboration: Serve as the liaison between healthcare providers, managed care organizations (MCOs), and regulatory agencies in California. Provide clear guidance to providers regarding credentialing requirements and timelines and respond to inquiries promptly. Renewals and Appeals: Manage provider contract and credentialing renewals within California-specific timeframes. Facilitate appeals and resolution of disputes related to provider denials or credentialing errors as per California laws and managed care regulations. Process Improvements: Identify areas for streamlining credentialing workflows specific to California's unique healthcare system. Stay informed of changes in California managed care regulations and implement adjustments as needed. Qualifications and Skills: Educational Background: Associate’s or Bachelor’s degree in healthcare administration, business, or a related field, or equivalent experience. Experience: Minimum of 2-3 years of experience in credentialing, preferably within a managed care or California-based healthcare organization. Technical Proficiency: Familiar with credentialing software and electronic medical records (EMR) systems (e.g., Cerner, Epic). Knowledge: Deep understanding of California-specific healthcare credentialing laws and managed care guidelines. Familiarity with standards from NCQA, CMS, and The Joint Commission. Skills: Exceptional attention to detail and organizational skills. Strong verbal and written communication. Ability to manage multiple priorities in a fast-paced environment. Preferred Certifications: Certified Provider Credentialing Specialist (CPCS) by the National Association Medical Staff Services (NAMSS). Familiarity with California Department of Managed Health Care requirements is highly valued. Salary Range (2025): This tailored job description will help target candidates with the necessary expertise in managed care and California-specific regulations, ensuring they are prepared to meet the unique demands of the role. Requirements EHR SYSTEM, Auditing, Compliance, Council for Affordable Quality Healthcare (CAQH), Credentialing, Credentialing Processes TalentMatch® Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles. Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more. All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information. © 2025 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to Robert Half’s Terms of Use (https://www.roberthalf.com/us/en/terms) .