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2 results for Credentialing Specialist in Riverside, CA

Credentialing Manager

Long Beach, CA
onsite
Temporary / Contract
32 - 45 USD / Hourly
A healthcare company is looking for an experienced Credentialing Manager to lead credentialing and provider data activities for a healthcare organization in Long Beach, California. This Credentialing Manager position will guide daily operations related to provider onboarding, recredentialing, enrollment support, and data accuracy while maintaining adherence to regulatory and health plan standards. The Credentialing Manager also partners with internal leaders to strengthen workflows, support audit readiness, and promote consistent credentialing practices across the function. Key Responsibilities:• Direct the day-to-day work of credentialing and provider data staff, setting priorities and providing operational guidance.• Lead provider onboarding, reappointment cycles, payer enrollment activity, and privileging coordination to keep processes moving efficiently.• Maintain compliance with applicable accreditation standards, delegated credentialing obligations, and state and federal regulations.• Review credentialing records, provider rosters, and supporting documentation to ensure information remains complete, current, and accurate.• Track team volume and turnaround times, remove workflow obstacles, and support timely resolution of credentialing issues.• Prepare the department for internal and external reviews by conducting audits and addressing gaps before formal assessments occur.• Work with leadership to refine credentialing policies, improve reporting, and enhance departmental procedures.• Oversee provider data integrity across systems and records to support reliable downstream use and regulatory reporting. Benefits: Health, Dental, Vision, 401k, and Sick Time Off.
2026-08-21T00:00:00Z

Quality Assurance Specialist

Irvine, CA
onsite
Temporary / Contract
28.5 - 33 USD / Hourly
We are looking for a Quality Assurance Specialist to support leave administration for employees in Irvine, California. This Long-term Contract position will oversee end-to-end leave cases, coordinate with internal partners, and help ensure a consistent, compliant experience for employees throughout their time away from work. The ideal candidate brings strong attention to detail, sound judgment, and the ability to communicate clearly and compassionately in sensitive situations. Responsibilities: • Oversee the administration of employee leave programs, including protected, disability-related, parental, and personal time away from work. • Coordinate with human resources, payroll, and benefits stakeholders to help maintain accurate compensation handling, benefits continuation, and return-to-work arrangements. • Track leave activity with precise documentation and maintain records that support compliance with applicable federal, state, and local regulations. • Guide employees through each stage of the leave process by explaining requirements, timelines, and next steps in a clear and supportive manner. • Review medical, administrative, and case-related documentation to ensure leave determinations and follow-up actions are handled appropriately. • Monitor case progress and follow up on outstanding items to support timely resolution and smooth transitions back to active work status. • Identify process improvement opportunities that strengthen operational efficiency and improve the overall employee leave experience. • Support quality assurance efforts by reviewing workflows, validating case accuracy, and helping maintain high service standards across leave administration activities.
2026-08-27T00:00:00Z