Credentialing Program Lead

Modern Health is a mental health benefits platform for employers. We are the first global mental health solution to offer employees access to one-on-one, group, and self-serve digital resources for their emotional, professional, social, financial, and physical well-being needs—all within a single platform. Whether someone wants to proactively manage stress or treat depression, Modern Health guides people to the right care at the right time. We empower companies to help all their employees be the best version of themselves, and believe in meeting people wherever they are in their mental health journey.

Modern Health is backed by investors like Kleiner Perkins, Founders Fund, John Doerr, Y Combinator, and Battery Ventures and raised more than $170 million in less than two years, making Modern Health the fastest entirely female-founded company in the U.S. to reach Unicorn status.

More about our culture and what you can expect when you join the team:

• “It Takes a Village” culture. Modern Health has a unique and unabashed culture centered around high empathy and high accountability - with a drive to win. We are energized by bringing together the best talent in the industry to achieve audacious goals focused on making mental health a strength and priority for all.
• We have an obsession to win. We are highly ambitious and passionate about the work that we do.  We take pride in delivering excellence and our personal best and we continuously innovate to uniquely solve our customers’ needs. 
• We are accountable and can rely on each other. We are a team and hold ourselves and each other accountable. We believe in transparent communication and continuous feedback to foster a culture of trust, reliability, and growth. 
• We demonstrate empathy. We have a supportive and diverse culture where we bolster and uplift each other as we pursue our lofty goals. We encourage selflessness and a willingness to support others, fostering a collaborative and respectful environment. 
• We exhibit a bias towards action. This is a fast-paced environment. We jump into problems and initiate solutions. We empower our people to make decisions and experiment, iterate, and repeat until we get it right. 

Modern Health is a fully remote workforce and a hyper-growth company that is often recognized for its excellence, winning awards such as World’s Most Innovative Companies of 2023 by Fast Company, Top 25 Companies of San Francisco 2023, and 2023 Well-Being Trailblazer Award. To protect our culture and help our team stay connected, we require overlapping hours for everyone. While many roles may function from anywhere in the world—see individual job listing for more—US based team members who live outside the Pacific time zone are expected to work at least six hours between 8 am and 5 pm Pacific time each workday.

We are looking for driven, creative, and passionate individuals to join in our mission. An inclusive and diverse culture are key components of mental well-being in the workplace, and that starts with how we build our own team. If you're excited about a role, we'd love to hear from you!

Modern Health is looking for a Credentialing Program Lead to lead and optimize our credentialing program for a growing provider network.

This is an individual contributor role to start. You will serve as the primary owner of credentialing program execution and continuous improvement, strengthening the policies, workflows, recredentialing standards, audit readiness, reporting, and governance already in place to support a scalable, compliant provider network.

This is a high-impact role for someone who is equal parts program lead, operator, and subject matter expert. You are comfortable improving existing processes, identifying gaps and opportunities, and translating regulatory requirements into practical, scalable workflows while driving cross-functional execution without direct people management.

This role is eligible for remote work within the USA, with the exception of Hawaii.

• →Lead and optimize Modern Health’s credentialing program, including initial credentialing, recredentialing, ongoing monitoring, exception handling, and documentation standards
• →Lead the administration and operations of the Credentialing Committee, including agenda development, case preparation, primary source verification review, documentation management, meeting facilitation, decision tracking, and follow-up activities.
• →Ensure credentialing and recredentialing activities are conducted in accordance with organizational policies, accreditation standards, regulatory requirements, and the enterprise quality governance structure.
• →Improve and scale policies, SOPs, controls, and governance processes aligned with regulatory and accreditation requirements
• →Define and refine program goals, SLAs, metrics, and reporting to monitor timeliness, quality, audit readiness, and operational performance
• →Streamline workflows for licensure, sanctions, exclusions, malpractice, expirables, renewals, and issue resolution
• →Serve as a key liaison across Provider Operations, Clinical Quality, Compliance, Legal, and Recruiting/Onboarding to strengthen provider credentialing oversight, mitigate organizational risk, support audit readiness, and drive accountability to Quality Committee priorities.
• →Identify process, tooling, and vendor opportunities that improve scalability, visibility, and provider experience
• →Serve as the credentialing SME for audits, escalations, governance reviews, and credentialing-related provider status decisions
• →Support day-to-day credentialing operations while driving a more scalable future-state model

• 5+ years of experience leading and optimizing credentialing programs, provider operations, provider enrollment, licensing, or a related healthcare operations function
• Experience administering Credentialing Committee activities, provider governance processes, audits, and regulatory reviews.
• Knowledge of credentialing and recredentialing standards, including NCQA, URAC, state regulatory requirements, and delegated credentialing arrangements.
• Experience improving credentialing infrastructure, policies, workflows, controls, or operating models in a growing environment
• Experience with credentialing software, provider data management systems, primary source verification tools, CAQH, NPDB, provider lifecycle management platforms and credentialing documentation requirements.
• Experience supporting audits, accreditation readiness, delegated credentialing oversight, or similar compliance programs
• Strong program management, analytical, and cross-functional communication skills
• Comfortable balancing strategic process improvement with hands-on operational execution.
•  Applicants must be able to maintain work authorization for the duration of employment without employer sponsorship or employer-provided training plans or attestations (including, for example, the Form I-983 required for STEM OPT). Immigration sponsorship is not available for this position.

• Experience in digital health, telehealth, behavioral health, or a multi-state provider network environment
• Experience with credentialing platforms, provider data systems, or vendor oversight
• Certified Provider Credentialing Specialist (CPCS), Certified Professional Medical Services Management (CPMSM), or equivalent credentialing certification preferred.

Within the first 12 months, this person has:

• Improved key credentialing policies, SOPs, and audit-ready documentation
• Strengthened SLAs, reporting, and governance mechanisms
• Regulatory-compliance credentialing, recredentialing, and ongoing monitoring
• Increased cross-functional alignment across Provider Operations, Clinical Quality, Compliance, Legal, and Recruiting / Onboarding
• Improved scalability, consistency, and operational execution as the provider network grows