Manager, Credentialing & Network Specialist (National)

at Zócalo Health

Remote (Full Time)

Compensation: $110,000 - $120,000 (per year)

About Us

Zócalo Health is a tech-enabled, community-oriented primary care organization serving people who have historically been underserved by the one-size-fits-all healthcare system. We partner with health plans, providers, and community organizations to deliver culturally competent primary care, behavioral health, and social care.

Our model is built for populations with high medical and social complexity, where fragmented care drives poor outcomes and unnecessary cost. We combine local, community-based teams with virtual care and modern technology to deliver coordinated, whole-person care where members live and receive support.

Founded in 2021, Zócalo Health is backed by leading healthcare and mission-aligned investors and is scaling rapidly across states and populations. We are building a durable care platform designed to perform in constrained healthcare environments and to lead the shift toward accountable, value-based care.

Role Description

The Manager, Credentialing & Network Specialist will join Zócalo Health during a period of rapid growth and increasing operational complexity. This role exists to help scale and execute a community-oriented primary care model that delivers measurable outcomes for high-need members and health plan partners.

As part of a fast-growing team, you will be responsible for building and operating Zócalo Health’s credentialing and enrollment infrastructure across California and new markets (New York, Maryland, Washington, and future states). This person ensures Zócalo’s clinical and community-based workforce is credentialed, compliant, and payer-ready so we can launch and expand health plan partnerships without delays.

This role is both hands-on and operationally strategic: you will directly own credentialing execution while also building the repeatable systems (SOPs, policies, forms, tracking mechanisms, and readiness workflows) that allow Zócalo to scale across payers, products, and states. You will act as the internal expert and point person for credentialing requirements spanning clinicians and community-based care teams (including CHWs), partnering closely with Implementation, Operations, and Payer Partnerships to ensure “ready-to-bill” network status across all health plan contracts.

This position reports to the Head of Payer Contracting and Strategy

The Manager, Credentialing will contribute in the following ways:

Credentialing & Enrollment Ownership (Multi-State + Multi-Payer)

• Own end-to-end provider credentialing and enrollment across Medicaid, Medicare, Medicare Advantage, and D-SNP payers, including maintenance of CAQH and payer systems, tracking of statuses, renewals, and effective dates to ensure uninterrupted network participation.
• Act as the primary internal coordinator for credentialing across providers, payers, and cross-functional teams, resolving issues and driving timely completion.
• Lead credentialing readiness for new payer launches, expansions, and ongoing payer requirements, ensuring standards and timelines are met to accelerate time-to-revenue and maintain payer trust.
• Partner with Implementation and Operations to confirm credentialing completion prior to handoffs and go-lives.

Compliance, Audit Readiness & Workforce Standards

• Ensure credentialing policies and documentation meet payer and regulatory requirements (e.g., CMS, NCQA, state Medicaid agencies, and payer-specific standards).
• Maintain audit-ready credentialing files and documentation to support payer reviews, compliance checks, and Medicare Advantage/D-SNP oversight.
• Monitor and track clinician licenses, board certifications, and required documentation (as applicable), including renewal workflows and proactive outreach.

Community-Based Workforce Credentialing & Compliance (CHWs and Similar Roles)

• Manage credentialing / eligibility requirements for community-based roles relevant to Medicaid and CalAIM delivery (e.g., CHWs), including certification pathways and ongoing compliance tracking.
• Build and maintain systems that track workforce readiness requirements such as certification status, training completion, supervision needs, and continuing education requirements where applicable.

Credentialing Infrastructure Build (SOPs, P&Ps, Forms, Systems)

• Build and continuously improve credentialing infrastructure, including:
  
  
• SOPs and policies/procedures
• standardized forms and credentialing packets
• onboarding checklists and job aids
• tracking systems and dashboards (credentialing status, payer readiness, expirables)
  
  
• Identify bottlenecks and implement process improvements to reduce credentialing cycle times and improve readiness accuracy.

Cross-Functional Leadership & Stakeholder Management

• Operate as a trusted cross-functional partner to Payer Partnerships, Implementation, Operations, and Clinical leaders.
• Communicate clearly and proactively when credentialing risks threaten timelines, launches, or payer requirements.
• Create clarity and accountability around credentialing ownership, timelines, and required inputs.

Qualifications

• 5+ years of experience in provider credentialing, enrollment, or healthcare network operations
• Hands-on experience managing CAQH profiles
• Experience credentialing providers across Medicaid and Medicare (Medicare Advantage and/or D-SNP highly preferred)
• Strong operational judgment, attention to detail, and comfort owning complex workflows end-to-end
• Proven ability to build repeatable systems (trackers, SOPs, documentation, workflows) in a scaling environment
• Prior experience supporting payer audits or readiness assessments
• Strong communication skills and ability to work across multiple teams and priorities

Preferred Qualifications

• Experience supporting multi-state credentialing and/or rapid market expansion
• Familiarity with credentialing and compliance requirements tied to dual-eligible populations and managed care performance expectations
• California experience (Medi-Cal / CalAIM) strongly preferred

What you can expect from Zócalo Health

• Competitive salary: $110k - $120k (depending on experience)
• Equity compensation package
• Comprehensive benefits including medical, dental, and vision
• 401k
• Flexible PTO policy - take the time you need to recharge
• $1,000 home office stipend
• We provide the equipment needed for this role.
• Opportunity for rapid career progression with plenty of room for personal growth.

You must be authorized to work in the United States. Remote Work can be done from anywhere in the U.S.

At Zócalo Health Inc., we see diversity and inclusion as a source of strength in transforming healthcare. We believe building trust and innovation are best achieved through diverse perspectives. To us, acceptance and respect are rooted in an understanding that people do not experience things in the same way, including our healthcare system. Individuals seeking employment at Zócalo Health are considered without regard to race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

Those seeking employment at Zócalo Health are considered without regard to race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status or disability status.