Job Description Provides leadership, management and operational oversight and strategic development of the Medical Staff Services Department which includes credentialing and privileging processes, medical staff quality review processes and assurance of compliance with medical staff bylaws and policies as well as all regulatory compliance including, but not limited to Joint Commission and the Maryland Board of Physicians
Principal Duties and Responsibilities
Works collaboratively with the Chief Medical Officer, President of the Medical Staff, Medical Executive Committee (MEC), and additional medical staff leaders to assure compliance with medical staff bylaws, policies and processes.
Responsible for leading, coordinating, monitoring, and maintaining the credentialing, privilege delineation, and re-credentialing process. Facilitates all aspects of UM SRH credentialing, including initial appointment, reappointment, expiration process, as well as clinical privileging for Medical Staff, Allied Health Professionals, and all other providers outlined in UM SRH Medical Staff Bylaws, policies, or related contracts.
Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing.
Responsible for the accuracy and integrity of the credentialing database system and related applications.
Ensures thorough background Job Summary
investigation, research and primary source verification of all components of the application file are completed timely and accurately.
Identifies medical staff issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up is conducted and documented.
Oversees and ensures proper preparation of credentials file for completion and presentation to UM SRH Medical Staff Committees, ensuring file completion within time periods specified.
Oversees and may process requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.
Oversees the Medical Staff Peer Review process- including the Medical Staff Quality Committee functions, Focused Professional Practice Evaluation, Ongoing Professional Practice Evaluation, and maintenance of the medical staff providers' quality improvement data and files.
Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
Assists with managed care delegated credentialing audits; conducts internal file audits.
Manages proper use and maintenance of the organization's credentialing database and peer review databases, optimizing efficiency.
Ensures that query, report and document generation are set up and maintained for maximum efficiency and effective use; ensures that staff submit and retrieve National Practitioner Database reports in accordance with Health Care Quality Improvement Act.
Conducts physician orientation to ensure that all new physicians and other providers are properly and timely oriented to applicable policies, procedures, and operations of UM SRH. Personally ensures that all physicians and providers are on boarded in a welcoming and effective manner.
Monitors the initial, reappointment and expiration process for all medical staff, Allied Health Professional staff, Other Health Professional staff, and delegated providers, ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, federal and state), as well as Medical Staff Bylaws, Rules and Regulations, policies and procedures, and delegated contracts.
Provides oversight of any medical staff mandates such as annual education, flu shot compliance, annual collection of medical staff dues, etc.
Assists with planning, agenda development and record keeping of various medical staff meetings which includes but is not limited to Credentials and Bylaws, Clinical Excellence Committees;
Performs miscellaneous job-related duties as assigned.
Company Description At Shore Regional Health, you can learn, grow and make a lasting impact on patients and families. You'll experience the support of a collaborative work environment and a sense of collegiality unlike any other. Our comprehensive system has many locations and practice options to choose from throughout the beautiful Eastern Shore of Maryland.
Qualifications
Minimum Qualifications and Required Competencies
Minimum Qualifications and Required Competencies
Bachelor's degree, master's preferred in a Healthcare field, preferably with Leadership coursework/or certification.
Minimum current RN License in the State of Maryland.
Minimum of five years' experience in acute patient care setting.
Minimum of 5 year experience in Medical Staff Office operations.
Minimum 5 years in knowledge of performance improvement programs and at least five years' directly related experience at a managerial level; or an equivalent combination of education and experience
NAMMS certification as a Certified Professional Medical Services Manager (CPMSM). NAMSS certification as a Certified Provider Credentials Specialist (CPCS) is acceptable upon hire. If not certified as CPMSM upon hire, must become certified within 48 months of hire.
Knowledge, Skills, Abilities
Ability to communicate effectively, both orally and in writing.
Skill in designing, planning and implementing programs and process related to assigned subject matter and area of functional responsibility.
Advanced knowledge of related accreditation and certification requirements.
Advanced knowledge of medical credentialing and privileging procedures and standards.
Ability to analyze, interpret and draw inferences from research findings, and prepare reports.
Working knowledge of clinical and/or hospital operations and procedures.
Informational research skills.
Ability to use independent judgment to manage and impart confidential information.
Database management skills including querying, reporting, and document generation.
Ability to make administrative/procedural decisions and judgments.
Skill in selecting, leading, supervising, and developing staff.
Additional Information All your information will be kept confidential according to EEO guidelines.
