Director of Provider Relations and Credentialing

About the position

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.

Responsibilities

• 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
• 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
• 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
• 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
• 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
• 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
• 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

Requirements

• 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.
• 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.

Nice-to-haves

• 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.

Benefits

• 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