Provider Network Strategy Manager

About Season

At Season Health, we're revolutionizing healthcare through our innovative telehealth platform. We connect patients with expert clinicians, including one of the largest networks of registered dietitians nationwide, to help them achieve meaningful health outcomes. Our integrated approach combines personalized clinical care with a curated marketplace featuring national and local vendors, all enhanced by our proprietary AI technology. By bridging the gap between medical guidance and daily decisions, we're empowering individuals and families to make sustainable health choices that demonstrably improve both clinical outcomes and quality of life.

We are fortunate enough to be backed by top healthcare and consumer VCs such as LRVHealth, 8VC, and Andreessen Horowitz.

About The Role

The Provider Network Strategy Manager will lead the strategic development and day-to-day operations of the credentialing function for our medical nutrition therapy (MNT) telehealth organization. This role will oversee provider credentialing with health plans, credentialing staff, and credentialing processes, and develop strategy to expand the organization's network relationships. The position requires deep understanding of both the operational and strategic aspects of healthcare credentialing in a telehealth environment using the MSO-PC model.

Note that this role is a hybrid role in LA or NYC, with a minimum expectation of 4 days per month at an office. For non local candidates, relocation assistance will be considered.

What You'll Do

Strategic Leadership

• Develop and implement the organization's network strategy, identifying priority markets, payers, and provider types based on business objectives
• Analyze market opportunities and regulatory requirements to determine optimal credentialing approaches by state
• Lead cross-functional collaboration with Clinical Operations, Product / Engineering, Business Development, Revenue Cycle, Legal, and Compliance teams to ensure alignment with business goals
• Create data-driven dashboards to track credentialing KPIs and revenue impact
• Partner with leadership to expand payer networks and provider roster in alignment with growth strategy
• Develops and articulates the overall credentialing strategy in alignment with organizational goals, providing guidance and expertise to other departments on credentialing implications.
• Leverages strong consultative abilities to understand the credentialing needs and challenges of various internal departments, ensuring seamless integration of credentialing processes with overall organizational objectives.
  
  

Operational Management

• Oversee the full credentialing life cycle from initial application through primary source verification to maintenance and re-credentialing
• Manage credentialing staff, including work allocation, professional development, and performance evaluations
• Design and implement efficient credentialing workflows to reduce time-to-credential metrics
• Maintain comprehensive documentation of credentialing policies and procedures
• Ensure compliance with NCQA, URAC, health plan, and state-specific credentialing requirements
• Develop and maintain relationships with key contacts at insurance companies and health plans
• Design and oversee standardized credentialing workflows with clear ownership of steps and define protocols to minimize time-to-credential across all provider types
• Lead regular process audits and continuous improvement initiatives, identifying optimization opportunities through data analysis and implementing solutions that increase throughput while maintaining quality
• Report on the metrics of progress and success on our credentialing processes
• Evaluate, select, and oversee the implementation of credentialing technology solutions that integrate seamlessly with the organization's internal platform, billing systems, and reporting tools, serving as the technical product owner for credentialing systems
• Collaborate with Product and Engineering teams to translate complex credentialing workflows into technical requirements, identifying opportunities for automation, AI-assisted verification, and data-driven prioritization to accelerate provider onboarding
• Ensure all providers are properly configured in the Product with respect to licensure and credentialing
• Develop and oversee a NCQA-compliant delegated credentialing process (to include policies and procedures; committee development; and auditing)
• Negotiate and implement delegated credentialing contracts.
• Partners with internal departments to thoroughly understand their credentialing requirements and challenges, offering tailored and efficient solutions during onboarding and ongoing maintenance.
• Actively monitors internal departments (and external) satisfaction with credentialing processes, gathering feedback to proactively identify and implement enhancements for improved efficiency and outcomes.
  
  

Communication & Authority

• Acts as or delegate the central point of contact and information funnel for all internal and external inquiries related to credentialing, ensuring consistent and accurate communication across all departments.
• Serves as the definitive source of truth and subject matter expert on all credentialing matters, including current status, processes, regulatory requirements, and strategic direction.
• Provides clear direction, leadership, and decision-making authority for the credentialing team and all credentialing-related efforts, ensuring efficient and compliant operations.
• Empowers the credentialing team through effective delegation, mentorship, and performance management, fostering a high-performing and knowledgeable unit.
• Develops and maintains strong relationships with key decision-makers and operational stakeholders across all internal departments, providing ongoing support and serving as a trusted resource for all credentialing inquiries.
  
  

Budget & Cost Savings

• Develops, manages, and monitors the Credentialing Department budget, ensuring cost-effective operations and identifying opportunities for savings.
• Responsible for identifying and implementing cost-saving initiatives within the Credentialing Department while maintaining compliance and efficiency.
• Analyzes credentialing trends and data to develop strategic recommendations that contribute to organizational cost savings, improved compliance, and enhanced operational efficiency.
  
  

Compliance & Quality

• Ensure adherence to all regulatory requirements related to provider credentialing and enrollment
• Establish quality control procedures to maintain data integrity across credentialing systems
• Prepare for and lead responses to audits from payers and accreditation organizations
• Stay current on evolving regulations and credentialing requirements across multiple states
• Implement continuous process improvement initiatives to enhance credentialing operations
• Experience with and/or ability to manage the complexities of compact licensure for Registered Dietitians (where applicable), ensuring compliance with individual state regulations and relevant interstate agreements.
  
  

About You

You should have:

• 5 years of experience in healthcare credentialing, with at least 2 years in a management role
• Experience with telehealth and multi-state credentialing required, and experience with credentialing MNT providers is preferred but not required
• Deep knowledge of CAQH, NCQA, and health plan credentialing requirements
• Thorough understanding of delegated credentialing standards, documentation requirements, and performance metrics with proven ability to navigate complex payer-specific requirements
• Proven track record scaling credentialing operations during periods of rapid growth, specifically experience growing provider networks while maintaining quality standardsUnderstanding of MSO-PC models and corporate practice of medicine considerations
• Familiarity with credentialing software platforms and database management
• Strong analytical and problem-solving skills
• Excellent interpersonal and communication abilities
• Bachelor's degree required; MBA or Master's in Healthcare Administration or related field preferred
• CPCS, CPMSM, or other credentialing certification highly desirable
  
  

What You Get

• A full-time role at a competitive wage with significant equity
• Medical, dental, and vision benefits provided to you and your dependents at no cost
• Option to participate in 401k plan
• Flexible work arrangements, including unlimited PTO
• Training, mentorship, and ability to learn in a fast-paced, high-growth environment
• An opportunity to use your skills to help improve people’s lives at a mission-driven company
  
  

Interested? How to Apply:

To apply, please send us your resume (no cover letter is required). If selected, you will be invited to a :30 minute phone screen to get an overall sense of your experience. Following a successful phone screen, you will be asked to return to meet with additional people to assess more in-depth your technical skill, knowledge, and working style.

More About Season

Season recruits, employs, compensates, and promotes regardless of race, religion, sex, national origin, ethnicity, gender identity, disability, age, veteran status and other protected status as required by applicable law and as a matter of our company ethics.

The Pay Range For This Role Is

110,000 - 130,000 USD per year(Hybrid (New York, New York, US))

110,000 - 130,000 USD per year(Hybrid (Los Angeles, California, US))