BASIC PURPOSE OF THE JOB

Manage the day-to-day work of the credentials specialists to assure compliance to CMS/TJC standards, high quality communication between the team and medical staff leadership, and efficient and accurate work product.

REPORTS TO

• Director of Quality & Patient Safety

JOB REQUIREMENTS

Supervisory Responsibilities: YES

Number of Direct Reports: 2

Minimum Education: Bachelor’s Degree or five (5) years in healthcare credentialing required.

Degree: Master’s degree preferred.

License/Certification Required: CPMSM Certification by NAMSS

Minimum Work Experience: 2 years of management experience required. 5 years healthcare medical staff/credentialing experience.

REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES

• Maintains knowledge, as the subject matter expert of state/federal laws, regulatory standards for accreditation purposes, and ETCH Bylaws, policies, and procedures.
• Sophisticated project management experience
• Independent decision making, sensitivity to the needs of senior leadership constituents and organization
• Proficient in the use of Office 365 applications, credentials software to manage applications, onboarding, privileging, and aptitude for learning additional software used in the organization.
• Proven customer service orientation, with demonstrated excellence in interpersonal communication skills including diverse populations.
• Track record of efficient prioritization and organization of multiple requests.
• Proven ability to work independently, manage priorities, handle multiple projects, problem solve and exercise judgment in a highly dynamic environment.

DUTIES AND RESPONSIBILITIES

• Oversees verification of information contained on applications.
• Oversees OPPE and FPPE process working with quality analysts.
• Maintains compliance with the accrediting and regulatory agencies (i.e., Joint Commission, NCQA, URAC, etc.) in regards to credentialing while maintaining a working knowledge of TN statutes and laws.
• Manages the flow of information between the Medical Staff and Credentials team and MEC Committee members, Medical Staff Leadership, the Director of Quality and Safety and the Chief Medical Officer.
• Manages the credentialing, appointment and reappointment processes, maintains necessary data sources for application components and reviews applications and other documents for completeness.
• Maintains accuracy and integrity of the credentialing and clinical privileging database system and for ensuring the timeliness of credentialing/re-credentialing verifications. Responds to verification requests from other organizations in a timely manner.
• Produces and manages the process for paper file conversion to credentialing software and web-based peer review system.
• Assists in developing and implementing medical staff policies.
• Responsible for coordination and preparation of medical staff functions; manages the team in preparation for committee meetings, minutes, processes and distribution of appropriate correspondence.
• Manages staff productivity.
• Implements supervision, development, and evaluation of direct reports.
• Performs other duties as assigned to contribute to department and organizational goals.

PHYSICAL REQUIREMENTS-Note: Reasonable accommodations may be made for individuals with disabilities to perform the essential functions of this position.

• Light lifting, pushing and pulling is required for 10-20 lbs occasionally and frequent moving of objects of less than 10 lbs is required. Frequent sitting with some walking, standing, squatting, bending and reaching is required. Keyboard/computer use and/or repetitive motions are required.

Come work where you can make a difference everyday.