Manager Medical Staff Credentialing

• DEPARTMENT: 18400 – Medical Staff
• LOCATION: 350 7th Street North, Naples, FL, 34102
• WORK TYPE: Full Time
• WORK SCHEDULE: 8 Hour Day

ABOUT NCH

NCH is an independent, locally governed non-profit delivering premier comprehensive care. Our healthcare system is comprised of two hospitals, an alliance of 700 physicians, and medical facilities in dozens of locations throughout Southwest Florida that offer nationally recognized, quality health care.

NCH is transforming into an Advanced Community Healthcare System(TM) and we’re proud to: Provide higher acuity care and Centers of Excellence; Offer Graduate Medical Education and fellowships; Have endowed chairs; Conduct research and participate in national clinical trials; and partner with other health market leaders, like Hospital for Special Surgery, Encompass, and ProScan.

Join our mission to help everyone live a longer, happier, healthier life. We are committed to care and believe there's always more at NCH – for you and every person we serve together. Visit nchjobs.org to learn more.

JOB SUMMARY

The Manager Medical Staff Credentialing serves as an expert in credentialing, privileging and accreditation requirements within the department and coordinates, monitors, and maintains regulatory compliance of credentialing/re-credentialing, privileging/re-privileging functions for all practitioners processed through the Medical Staff Office. Assists the Administrative Director in the development, planning and onboarding of the Medical Staff and Allied Health Practitioner Staff enabling them to fulfill their duties and obligations as defined by national and state regulatory agencies, Medical Staff Bylaws, Rules and Regulations, Credentialing Policy, and other related policies. Promotes and enhances good communication and positive working relationships between Administration and Medical Staff, contracted facilities, and health plans. Effectively manages credentialing verification organization program across the system as defined in Service Agreement(s). The Manager Medical Staff Credentialing serves as a valuable expert resource and is a role model for best practice for the team ensuring interpretation and compliance of the governing documents, regulatory agencies, and the accuracy and integrity of the department database systems. Will serve as the System Administrator for the MD Staff/MD Stat database, working independently with only administrative supervision, displaying independent judgment with the ability to overcome moderate obstacles and recognize early when issues should escalate. Manages day to day operation of database, implementations, downstream systems, and ensures accuracy of data and reporting from the database. Leads any/all projects with involvement of MD Staff/MD Stat database.

ESSENTIAL DUTIES AND RESPONSIBILITIES

– Other duties may be assigned.

• Manages the credentialing and accreditation program and team members including hiring, coaching, training, and performance management.

• Coordinates and monitors the accreditation, credentialing, privileging, and re-credentialing processes in a well-organized manner, pursuant to established policies and procedures.

• Assures timely processing of all credentialing/ privileging functions for Licensed Independent Practitioners and Allied Health Professionals, in an efficient manner, for recommendations to the appropriate committees (credentialing committee, medical executive committee, and board approval) in accordance with all governing documents, policies and procedures, and all regulatory bodies.

• Assures timely, accurate and efficient management of credentialing verification organization functions.

• Assist Administrative Director with planning, organizing, implementing, and overseeing the Medical and Allied Health Professional Staff credentialing process for appointment, reappointment, clinical privileges and/or membership.

• Manages the credentialing database systems to ensure all updates are made, by the team, in a timely manner as appropriate (demographic information, membership categories, appointment/reappointment dates, clinical privileges, expired information, tracking of FPPE/OPPE, etc.).

• System Administrator for MD Staff/MD Stat – resolves complex issues involving database performance, database capacity, resiliency, stability, replication, and other key aspects of distributed database technology.

• Provides 24/7 support of production database environments, demonstrating ability to solve complex issues independently.

• Provides service and information to Clinical Providers and additional Organizational departments as needed for MD Staff/MD Stat databases.

• Oversees initiatives with multiple application development team(s) to implement and support data-oriented development efforts that meet current and future business requirements.

• Streamlines end to end process in a paperless environment evaluating opportunities to optimize processes and improve workflow.

• Ensures uniform operations conform to hospital, medical group credentialing verification organization, managed care plans, and governmental and regulatory standards.

• Direct collection, verification and processing of all new Medical Staff and Allied Health Professional practitioner applications, reapplications, and privileges for review by the assigned governing committees.

• Participate with team coordinating orientation and onboarding for Medical Staff and Allied Health Professional staff.

• Oversees coordination of EMR training for new appointments to the Medical Staff and Allied Health Professional staff, including updates to the process, as it may be amended from time to time.

• Reviews, annually, all standardized credentialing forms used in the department for accuracy and updates, including delineation of clinical privilege forms and proctoring protocol.

• Oversees preparation and coordination of medical staff meetings; attends and reviews meeting materials and minutes as assigned, including follow up and preparation for reporting through the committee structure of the Medical Staff. Ensures distribution of appropriate correspondence (developing and utilizing standardized communication tools) and assures appropriate and timely follow up.

• Prepares accurate reports for medical staff departments, committees, peer review, medical staff meetings, administration, and other hospital departments.

• Maintains working knowledge of regulatory guidelines, including Medical Staff Bylaws, Rules and Regulations, Credentials Policy, Organizational Functions and Manual, hospital policy. Complies and provides recommendation for implementation of applicable changes to such documents.

• Oversees ongoing audits of credentialing records and reports deficiencies to the Administrative Director Medical Staff Services & Quality.

• Coordination of Medical Staff and Allied Health access into appropriate clinical areas and distribution of information for automation and picture identification.

• Maintains systems to identify (and disseminate to others) medical staff members and their clinical privileges, prepares and maintains other related records and reports.

• Team with Information Technology and Marketing to support internal and external facing practitioner information and scheduling platforms.

• Collaboration with team coordinating emergency room on call schedules pursuant to EMTALA and Rules and Regulations.

EDUCATION, EXPERIENCE AND QUALIFICATIONS

• Minimum of a bachelor’s degree with 3 years of experience in diversified hospital, healthcare, or Medical Staff Services.

• Strong knowledge/experience with MD Staff/MD Stat or other electronic credentialing database system required.

• NAMSS Certification for CPCS or CPMSM required or obtained within one year of hire.

• Flexibility, perseverance, fortitude, and excellent written/verbal communication skills.

• Comprehensive expertise and knowledge in the arena of medical staff leadership and ability to initiate and maintain collaborative and cooperative interdisciplinary relationships.

• Strong project management, extensive knowledge of computers, database management, information retrieval and report formatting.

• Intermediate computer knowledge: Uses Microsoft Word, Excel, Outlook, and Windows