Director, Provider Licensure, Credentialing & Compliance

The Director will work closely with VBC Operations and Clinical Leadership, HOPCo Legal/Compliance, Credentialing, Human Resources, Product/Technology, and external vendors to translate complex and changing state requirements into standardized, measurable, and sustainable operational controls. The successful candidate will demonstrate a strong track record of leadership in provider licensure and credentialing, exceptional organizational and process-management capabilities, and a demonstrated ability to convert regulatory requirements into workflows that are consistently co0mpleted, documented, monitored, and maintained. 

ESSENTIAL FUNCTIONS 

1. Multi-State Licensure, Credentialing & Continuing Education 

Plan licensure, registration, and collaboration coverage in advance of new states, programs, and provider types so clinicians are practice-ready on launch timelines. 

Oversee the provider compliance risk framework: identify, assess, and prioritize risks across states and provider types, and implement mitigation plans and controls. 

Establish governance for the function, including policies, procedures, KPIs, and escalation protocols, with clear decision rights and escalation paths to Legal/Compliance. 

Provide regular reporting on provider readiness, licensing status, state coverage, emerging risks, and compliance performance, with recommended actions. 

Oversee initial, additional-state, renewal, and reinstatement licensure for all VBC clinicians, monitoring applications, board correspondence, and deficiencies through completion. 

Maintain complete and accurate records of licenses, certifications, credentialing status, and state-specific telehealth, prescribing, and controlled-substance registrations. 

Track CME and continuing education requirements by provider type and state, including state-mandated topics (e.g., prescribing, controlled substances, pain management, ethics, telehealth), and incorporate them into license-renewal workflows. 

Establish advance notification and escalation processes for upcoming expirations and education deadlines to prevent interruptions in provider eligibility. 

Coordinate payer credentialing and enrollment activities as applicable to the VBC clinical model. 

2. Collaborative Practice, Supervision & State Board Compliance 

Serve as the organization’s operational authority on state-specific collaboration, supervision, delegation, scope-of-practice requirements, and physician-to-APP ratios by provider type. 

Ensure required physician-to-APP and other collaborative or supervisory relationships are established and maintained, along with related agreements, delegation documents, and practice protocols. 

Track and evidence required recurring activities, including physician-APP meetings, chart reviews and clinical record audits (frequency, volume, and documentation), and attestations, in an auditable system. 

Manage state board reporting, filing, notification, and attestation requirements, including initial agreement filings, recurring renewals, and event-driven notifications (e.g., changes in supervising physician, provider status, or practice arrangements) within required timeframes. 

Maintain documentation of submissions, acknowledgements, approvals, and regulatory correspondence, with clear accountability and escalation for incomplete or overdue requirements. 

3. Compliance Infrastructure, Regulatory Change & Audit Readiness 

Build and maintain a centralized provider compliance framework and single source of truth showing whether each provider is fully eligible to practice in each applicable state. 

Convert regulatory requirements into defined tasks, due dates, workflows, alerts, and escalation rules that are hardwired into systems rather than dependent on individual memory or manual follow-up. 

Serve as operational owner of credentialing and compliance tracking platforms, and partner with Product/Technology to automate workflows and incorporate provider-state compliance status into scheduling and other operational systems. 

Develop dashboards and exception reporting on provider readiness, outstanding requirements, upcoming expirations, compliance risks, and state coverage. 

Lead a systematic regulatory change management process: monitor changes in state laws, board rules, and scope-of-practice requirements; evaluate impact with Legal/Compliance; update workflows, agreements, policies, and system logic; communicate changes to affected stakeholders; document each step; and periodically revalidate existing state requirements. 

Maintain provider records in a continuously audit-ready state with appropriate retention and version control; conduct periodic internal audits, drive corrective action, and lead responses to inquiries or audits from medical and nursing boards, payers, accreditation organizations, and other regulators. 

4. People Leadership, Cross-Functional Partnership & Vendor Management 

Lead, develop, and retain a team of 1–2 direct reports, establishing clear roles, performance expectations, metrics, and operating rhythms for productivity, quality, timeliness, and compliance. 

Coach team members through regular feedback, goal setting, and professional development, building a culture of ownership, continuous improvement, and proactive risk management. 

Identify opportunities to automate, streamline, or redistribute work to improve scalability and reduce operational risk. 

Partner with VBC Operations, Clinical Leadership, Legal/Compliance, Credentialing, Human Resources, and Product/Technology, escalating regulatory interpretation questions to Legal/Compliance while retaining ownership of operational implementation. 

Other duties as assigned. 

 

EDUCATION 

• Bachelor’s degree in healthcare administration, business administration, nursing, health sciences, compliance, or a related field required. 

• Master’s degree in healthcare administration, business administration, public health, or a related field preferred. 

• Equivalent combination of education and substantial relevant experience may be considered. 

• Relevant credentialing, compliance, or medical staff services certification (e.g., CPCS, CPMSM, CHC) preferred. 

EXPERIENCE 

• Minimum 5-7 years of progressive experience in provider licensure, credentialing, provider compliance, medical staff services, telehealth operations, or a related healthcare function, including at least 3 years in a leadership role with direct people-management responsibility. 

• Demonstrated experience in strategic planning, risk assessment, and building compliance governance (policies, controls, KPIs) for a growing or multi-state organization. 

• Demonstrated experience managing requirements for clinicians practicing across multiple states. 

• Direct experience managing physician, nurse practitioner, and/or physician assistant licensing and regulatory requirements strongly preferred. 

• Experience administering collaboration, supervision, delegation, or similar APP practice requirements. 

• Experience working with state medical boards, nursing boards, and other professional licensing authorities. 

• Experience managing credential expirations, renewals, continuing education requirements, board filings, and regulatory reporting. 

• Experience within a national telehealth, digital-health, virtual-care, or multi-state healthcare organization strongly preferred. 

• Direct experience with provider compliance and credentialing platforms (e.g., Zivian, Medallion, CertifyOS, symplr, or similar) strongly preferred. 

• Experience developing scalable workflows, dashboards, trackers, and audit-ready compliance processes. 

KNOWLEDGE 

• Strong knowledge of healthcare provider licensure and credentialing processes. 

• Strong knowledge of state-specific physician, NP, and PA practice requirements. 

• Working knowledge of collaboration, supervision, delegation, and scope-of-practice requirements. 

• Knowledge of state medical and nursing board processes, reporting requirements, and regulatory expectations. 

• Knowledge of continuing education, professional registration, renewal, and credential-expiration requirements. 

• Understanding of telehealth and multi-state clinical practice considerations. 

• Knowledge of payer credentialing and enrollment processes preferred. 

• Understanding of compliance governance, risk management, internal controls, audit documentation, record retention, and regulatory change-management processes. 

• Working knowledge of provider compliance technology and workflow automation systems. 

SKILLS 

• Strategic planning and executive communication skills, including the ability to present risk and readiness information to senior leadership. 

• Proven people-leadership skills, including hiring, coaching, and managing team performance. 

• Exceptional organizational and project-management skills with the ability to manage large numbers of provider-state requirements simultaneously. 

• Strong attention to detail and ability to identify gaps, inconsistencies, expirations, or compliance risks. 

• Strong ability to translate complex regulatory requirements into practical workflows and measurable controls. 

• Strong process-development and continuous-improvement skills. 

• Strong written and verbal communication skills. 

• Strong analytical skills and ability to develop dashboards, exception reporting, and compliance metrics. 

• Effective vendor-management skills. 

• Strong technology aptitude and ability to work with compliance platforms, credentialing systems, databases, and workflow tools. 

• Ability to operate effectively in a fast-paced, matrixed healthcare organization. 

ABILITIES 

• Ability to maintain a comprehensive and current view of provider requirements across multiple states and provider types. 

• Ability to distinguish requirements applicable to physicians, NPs, PAs, PTs, and other provider categories and operationalize those differences. 

• Ability to build systems that proactively identify upcoming requirements rather than react to missed deadlines. 

• Ability to maintain accurate, auditable documentation supporting compliance with state-specific requirements. 

• Ability to identify regulatory changes and rapidly incorporate them into established processes. 

• Ability to collaborate effectively across clinical, operational, technical, legal, compliance, and administrative functions. 

• Ability to manage multiple concurrent deadlines while maintaining accuracy and regulatory compliance. 

• Ability to escalate legal or regulatory interpretation issues appropriately while retaining ownership of operational execution. 

• Ability to communicate compliance risks and required actions clearly to providers, managers, and executive leadership. 

ENVIRONMENTAL WORKING CONDITIONS 

• Normal office environment. 

• Some travel, as needed, for organizational meetings, provider meetings, or other business purposes. 

PHYSICAL/MENTAL DEMANDS 

• Requires sitting and standing associated with a normal office environment. 

ORGANIZATIONAL REQUIREMENTS 

• HOPCo Mission, Vision, and Values must be read and signed. 

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities, and working conditions may change as needs evolve.