Manager - Medical Staff Office/Credentialing

HonorHealth • Phoenix, AZ

4d • Onsite

About The Position

Manages the centralized appointment and reappointment process for Network facilities, in accordance with applicable regulatory and accrediting standards, to ensure that only qualified practitioners provide care within the network facilities. Coordinates and provides administrative support to the Credentials Committees of the HonorHealth Medical Staff. Promotes and facilitates integration and standardization between Network facilities as relates to credentialing, reappointment, and bylaws and policies of the Medical Staff.

Requirements

• Associate's Degree or 2 years' work related experience - Required
• 3 years credentialing - Required
• Must have one of the required certifications: CPCS OR CPMSM
• Certified Professional Medical Services Management (CPMSM) from the National Association Medical Staff Services. (NAMSS) - OR Certified Provider Credentialing Specialist Credentialing Specialist (CPCS) from National Association Medical Staff Services (NAMSS) Upon Hire - Required

Nice To Haves

• Supervisory experience - Preferred

Responsibilities

• Oversees the development and implementation of systems and processes for Medical Staff and credentialing of Medical Staff to Network facilities.
• Maintains a working knowledge of current legal issues specific to credentialing, to ensure all processes are in compliance with state statutes and regulatory agencies.
• Provides consultation to Administration and to the Medical Staffs regarding credentialing, or other issues relating to the Medical staff.
• Keeps Administration and the Director informed of issues related to credentialing and reappointment and suggests strategies for resolution.
• Collaborates regularly with Director and others regarding needs and issues related to credentialing and reappointment.
• Develops and maintains credentialing/reappointment policies, medical staff policies and procedures/credentialing manual.
• Protects confidential information for peer review by the authorized hospital and medical staff personnel.
• Reviews and analyzes physician applications and credential documents for completeness and in accordance with Medical Staff standards.
• Ensures the physician files contain all documents following established guidelines.
• Completes credentialing investigations and verifications following established guidelines.
• Coordinates such findings with the Director and appropriate Medical Staff Coordinator for review with appropriate physician leadership and administration.
• Provides administrative support to the Credentials Committees of the medical staff’s.
• Plans and develops supporting documentation per established medical staff policies.
• Organizes and plans with the Director DV and HH System Medical Staff Services & Network Credentialing, appropriate Medical Staff Coordinator, Hospital Administration & Credentials Committee Chair to achieve an efficiently run meeting.
• Maintains the credentialing and EMR databases for HonorHealth facilities.
• Modifies the credentialing database for defined data field uses.
• Ensures data is accurately entered as evidenced by audit.
• Prepares reports in compliance with requests for information as demonstrated by documentation.
• Supports appropriate utilization of organization’s resources.
• In collaboration with Director develops a budget to support the credentialing process or Medical Staff office.
• Approves expenditures requiring management review.
• Adheres to budgetary guidelines.
• Under the direction of the Director, participates in budget process including but not limited to any costing, projections, and monthly financials involved with the department.
• Works with finance and accounting to investigate or resolve any discrepancies.
• Ensures high quality and costs effective operations.
• Follows finance/accounting policies and procedures consistent with established guidelines and processes.
• Provides education to appropriate staff and physicians about credentialing and Medical Staff issues and processes.
• If applicable Coordinates and oversees all activities of assigned Medical Staff departments/committees.
• Researches and prepares information for various Chairmen and follows through on Medical Staff issues and actions.
• Prepares agendas at least one week prior to meeting.
• Accurately document minutes within 72 hours following meeting.
• Meeting follow-up initiated within one week following meeting.
• Protects confidential information for peer review by the authorized hospital and medical staff personnel.
• Provides assistance with the audio visual equipment for medical staff meetings or other meetings.
• Sets up equipment when requested and troubleshoots when there are problems.
• Maintains knowledge of and provides consultation to Medical Staff regarding credentialing, privileging, parliamentary procedure and disciplinary processes as well as peer review processes according to medical staff bylaws, rules and regulations, hospital and medical staff policies, accrediting bodies, CMS, state and other regulatory agencies.
• Maintains confidentiality with respect to all peer review and sensitive issues; uses judgment and discretion to maintain peer review protection for the hospital and medical staff.
• Coordinates, administers and maintains quality control on all aspects of physician and allied health credentialing and reappointment process with appropriate time frames ensuring the quality of practitioners providing care.
• Coordinates with department chairs regarding applicant document verifications and follows up on committee actions for application files.
• Requests additional information/clarification from external medical sources if necessary.
• Understands and maintains in a timely manner an accurate, secure and updated computerized database of physician and allied health information to query on demographic profiles including but not limited to staff privileges and category status for other hospital departments and facilities requiring this information.
• Generates appropriate forms and reports available from the medical staff database.
• Monitors the status of staff members in the Provisional and Leave of Absence categories and assures appropriate and timely review by the department chairmen at the conclusion of period specified in the appropriate bylaws.
• Assures the completeness and accuracy of the credentialing process.
• Coordinates the initial credentialing and privileging delineation activities and re-credentialing/re-privileging of the medical/allied health staff in accordance with the Bylaws, Rules and Regulations, Credentials Manual, and Policies of the Medical Staff and the appropriate medical staff departmental rules and regulations to assure that only qualified practitioners are appointed to provide care in the Hospital.
• Processes requests for and monitors duration of temporary privileges in accordance with the Bylaws, Rules and Regulations of the Medical Staff.
• Obtains appropriate approvals and distributes notices of temporary privileges granted.
• When applicable processes variance reports in a timely manner according to policy.
• Coordinates database entry and management of information with Quality Department regarding physician responses and chairmen disposition letters.
• When applicable coordinates and manages the Professional Performance Reviews (PPR’s) and the Professional Review Committee (PRC) investigation process , document findings and provides information regarding Chief Medical Officer and Department Chair recommendations to the Chief of Staff and ultimately if necessary the PRC or other appropriate personnel.
• Notifies the practitioner involved as required in the appropriate policy and as deemed necessary.
• Coordinates and completes special projects in a timely manner.
• Appropriately prioritizes all tasks so that deadlines are met with continued focus on quality.
• Keeps staff apprised of any critical or major situations.
• Drafts and assists in writing and reviewing policies and procedures and department rules and regulations.
• Ensures these do not conflict with medical staff by-laws and hospital policies and procedures/protocols.
• Manages, coordinates and maintains accurate on-call schedules for Emergency Department coverage.
• Creates on-call schedules across all campuses per contractual obligations and department rules and regulations.
• Verifies criteria for eligibility for Emergency Department call schedules including verification of patient volume, case review and meeting attendance in accordance with the medical staff department rules and regulations.
• Coordinates interface between department chairmen to ensure compliance with COBRA/EMTALA regulations and to assign physicians in a fair and equitable manner on the call schedules.

Benefits

• Great care starts with great people.
• Our culture is built on warmth and neighborly kindness.
• We’re delivering a healthcare experience that simply feels better through:
• Nine acute-care hospitals
• Over 200 primary, specialty and urgent care centers
• More than 17,000 team members and 4,000 medical staff
• Since 1927, we’ve been focused on doing what matters most — caring for people and communities across the greater Phoenix area.
• From humble beginnings to one of Arizona’s largest nonprofit healthcare systems, we’re just as driven as we were a century ago.
• Come join us and go all in for your career.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: Associate degree