Director Credentialing and Medical Staff Affairs

Monument Health•Rapid City, SD

4d•Onsite

About The Position

The Director Credentialing and Medical Staff Affairs provides direct leadership and strategic leadership along with subject matter expertise supporting the VP of Medical Affairs, Chief of Staff, and other Medical Staff leadership, VP of Managed Care, the Safety and Risk Management department, physician recruitment, quality department and compliance. The role is critical in advancing our missing to “Make a difference, Every Day” providing support and expertise to our physician leaders and other administrative partners. The Director provides direct leadership and strategic subject matter expertise and support as it relates to provider credentialing, privileging, medical staff functions, provider and facility enrollment, bylaws, and medical staff governance processes. The Director is the administrative and subject matter expert for the medical staff (5 independent hospital locations for Monument Health System) and hospital system administrators. Leadership accountability will be expected in managing practitioner competency systems, recognizing opportunities for improvement, monitoring performance of personnel in MSS as well as the various Medical Staff Departments and Committees, policies, procedures and legal governance documents, support of medical staff leadership, medical staff services operations, medical staff and hospital collaboration and demonstrates leadership by supporting and promotion current practices and by using and integrating current and future technologies.

Requirements

Bachelors degree in Business Administration Management or related field or equivalent combination of education and experience can be considered to satisfy the bachelor’s degree requirement
Light work - Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects.

Nice To Haves

Masters degree in Healthcare
3+ years of Leadership Experience
5+ years of Medical Staff Experience
Certified Professional Medical Services Management (CPMSM) - Accredited University or accredited training professionals
National Association of Medical Staff Services (NAMSS) Certification - Accredited University or accredited training professionals

Responsibilities

Strategic leader and subject matter expert for Credentialing, Privileging, and Peer Review
In conjunction with the CMO, VPMA and VP dyad partners, seeks to improve and implement the strategic plan for the operations of the department.
Responsible for developing processes that support the medical/professional staff and their responsibilities as it relates to Joint Commission, CMS and NCQA accreditation compliance, Network and Rapid City Bylaws and the hospital’s mission and strategic plan.
Directing, providing oversight and strategic leadership developing sustainability for credentialing, privileging, expirables, and appointment processes.
Developing and maintaining key performance indicators monthly reporting to track progress of appointments, reappointments, changes in status and enrollment along with financial impact of any delays or related denials.
Comprehensive knowledge and ability to create procedures and techniques that impact privilege and proctorship plans.
Maintaining, creating and updating privilege forms to fit all specialties.
Maintain, create, and modify existing department policies to maintain accreditation standards for NCQA and related payer delegation agreements.
Coordinate, maintain and review two (2) sets of Bylaws and Governing Documents to ensure that all accreditation standards and Conditions of Participation are continuously met.
Coordinate and review all changes and reporting in Credentialing Software. Direct oversight and planning of credentialing.
Provides senior level administrative support to the VPMA, Chief of Staff, CMO, department and committee chairs, medical staff and VP dyad leaders for Medical Staff Office.
Manage processes and assure appropriate documentation related to investigative, disciplinary and legal proceedings, such as fair hearing and appeals.
Design, create and implement improvements to MSO, Credentialing and payer enrollment process workflows.
Recruit, select, assist with training, and manage assigned staff.
Provide regular performance evaluations and educational opportunities for assigned staff to promote professional growth.
Partner with finance team in supporting projects related to provider & facility enrollment, credentialing and accreditation standards (i.e. location changes, new services lines, delegation of credentialing, accreditation support for new and existing programs).
Remains agile and flexible while anticipating future trends/opportunities. Fosters an environment of innovation, creation and implementation of new services and sustainability.
Self-driven and able to work independently.
All other duties as assigned.