Senior Director, Medical Staff Services

University of Rochester•City of Rochester, NY

4d•Onsite

About The Position

As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive.

Requirements

Bachelor’s Degree required in business or healthcare related field or equivalent combination of education and experience.
Seven years of combined medical staff services management experience and successful management experience in a large, complex healthcare organization.
Extensive experience in credentialing and privileging, and payer enrollment functions.
Previous experience and with The Joint Commission, CMS and other healthcare regulatory agencies.
Excellent interpersonal and communication skills with the ability to develop and maintain relationships with a variety of key stakeholders across the organization.
Demonstrated success in leading through change while utilizing effective change management tools.

Nice To Haves

Master’s Preferred.
Certified Professional Medical Services Management (CPMSM) and/or Certified Practitioner Credentialing Specialist (CPCS) preferred.

Responsibilities

Provides executive oversight of the health care practitioner credentialing, clinical privileging, and payer enrollment processes for the UR Medicine Health Care System and other outside health care contracted organizations.
Provides executive oversight of the enterprise software platform utilized throughout the UR Medicine Health Care System to carry out these functions.
Responsible for establishing the operational plan for credentialing, privileging and payor enrollment including the establishment of common practices/processes across the system that meet stakeholder expectations, achieve financial objectives, and reduce liability and risk.
Works in close partnership with the University of Rochester Medical Center (URMC) Information Systems Division, URMC Office of Integrity and Compliance, URMC Office of Quality Assurance, URMC Office of Counsel, University of Rochester Medical Faculty Group, SMD Office of Academic Affairs, and Affiliate Hospitals to enhance efficiency, accuracy, compliance, data-driven decision-making and to drive operational excellence and advance the quality of health care practitioners and patient safety of the organization and community.
Provides executive oversight of the robust practitioner credentialing and data management system that ensures the accuracy and completeness of practitioner information that supports the organization’s data needs in alignment with IT services.
Provides executive oversight of the specialty specific, criteria based electronic clinical privileging system (specialty specific procedure descriptions linked to CPT codes) implemented at all UR Medicine Health Care Facilities, assuring compliance with regulatory requirements, accreditation standards and organizational policies.
Coordinates and collaborates with physicians, dentists and allied health practitioner leaders throughout the UR Medicine system to assure compliance with the criteria based clinical privileging description regulatory requirements.
Responsible for the development and maintenance of the MSS Department Website which serves as a tool for leaders, staff and practitioners throughout the system to access information related to practitioner credentialing and payer enrollment and to obtain applications, reports and required documents and forms.
Oversee the collaboration of the MSS IT team with the University IT and Security teams, Web Services and the eRecord team to ensure the secure and efficient operation of the credentialing technology.
Directs the practitioner (physician and allied health practitioners - employed & non-employed) credentialing and re-credentialing application process for medical staff membership and clinical privileges for the UR Medicine Health System affiliated hospitals, nursing homes, surgical centers and health centers as well as for other non-affiliated regional contracted health care organizations. This includes credentials verification and background investigation of education, training, malpractice claims history, clinical experience and competence, specialty certifications and other data collection as required by the Joint Commission, CMS, NYS, NCQA, and the applicable entities’/hospitals’ bylaws and credentialing policies.
Ensures that files are complete and securely submitted to the respective entities upon completion and in accordance with the requirements of their contracts.
Directs the Strong Memorial Hospital (SMH) and Highland Hospital (HH) Clinical Chiefs’ & Chairs’ electronic review of the practitioner’s credentialing and recredentialing applications which includes verified credentials and the specialty specific clinical privileges requests for each practitioner.
Responsible for presenting the documented Clinical Chiefs’ & Chairs’ recommendations for clinical privileges and membership to the Credentials Privileges and Review Committees (CPRC) for Strong Memorial and Highland Hospital.
Directs the Credentials Privileges and Review Committee Meetings (Weekly & Monthly) for SMH and HH and ensures that meeting minutes are documented accurately and timely and presented to the hospitals’ respective Medical Executive Committees and Boards for final approval.
Responsible for maintaining records and minutes.
Communicates directly with the Hospitals’ Clinical Chiefs & Chairs, CPRC Chair and other clinical leaders, regarding concerns with respect to practitioners’ quality of care and competence as identified in the credentialing process as well as ongoing monitoring processes.
Directs the clinical departments’ electronic review process for Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practitioner Evaluation (FPPE) at SMH and HH, which are required for compliance with regulatory and accreditation requirements.
Responsible for updating the hospitals’ OPPE/FPPE policies from time to time.
Provides direction to hospital leadership in their provision of recommendations pertaining to credentialing and privileging.
Collaborates with and provides support to the System’s regional affiliated hospitals with respect to processes and issues related to credentialing and privileging, and advises on best practices to ensure high quality, consistent processes.
Audits, assesses, procures, implements, effectively utilizes and maintains practitioner credentialing processes and information systems (e.g., files, reports, minutes, databases) including analyzing needs and resources.
Provides direct leadership and oversight of the payer enrollment functions under URMFG’s Delegated Credentialing and Commercial Payer Enrollment Contracts, pursuant to which URMFG providers are credentialed with third party payors to provide services billable to the payers.
Reviews new and existing delegated credentialing contracts and advises, the URMFG Contracting Department on terms and conditions necessary to meet regulatory and accreditation standards, as well as consistency with URMC processes.
Provides direct leadership and oversight of the payer enrollment functions for enrolling practitioners with the Government Payers (Medicare & Medicaid) and with commercial payers with which URMFG does not have delegation contracts.
Serves as a Delegated Official for the Center for Medicare and Medicaid Services on behalf of URMFG for Practitioner Group and Individual Applications to participate in the government programs as required for payment for physician and APP services. This includes the electronic submission of applications through the Government’s online system, PECOS.
Develops and update URMFG, SMH and HH governing documents (bylaws, credentialing policies, rules and guidelines) that support and direct organizational practices.
Ensures continuous compliance with accreditation and regulatory standards of The Joint Commission (TJC), Center for Medicaid and Medicare Services (CMS), National Committee for Quality Assurance (NCQA), State Department of Health, Occupational Health and Safety Association (OSHA), Delegated Commercial Payers and other regulatory agencies that govern healthcare providers.
Serves as the Medical Staff Services leader during regulatory surveys of for SMH and HH and serves as a backup for the other affiliates.
Directs the ongoing compliance monitoring of practitioner’s credentials including but not limited to health review requirements (OSHA), professional licensing, DEA, and board certification.
Directs the ongoing monitoring and evaluation of sanctions, complaints, and adverse data for all practitioners to recommend action by medical staff and/or organizational leadership.
Facilitates efficient due process that complies with an organization’s fair hearing and appeals policy as well as applicable legal and regulatory requirements.
Identifies and reports adverse actions taken against practitioners in accordance with applicable law and contractual requirements.
Complies with and provides leadership in the various accreditation and regulatory audits.
Serves as the Financial Officer: Prepares, recommends and controls budgets totaling over $2m; Prepares long range forecasts. Approves expenditures, allocates funds.
Directs the billing and accounts receivable process for Credentials Verification Services provided to affiliates and non-affiliate clients.
Serves as the primary institutional contact for multiple vendors for subscriptions required for verifying credentials of URMC applicants such as ABMS, AMA, ANCC, AOIA, DEA, Certifacts, ClassMarker Pty. LTD, ECMFG, FSMB, NPDB and PluralSight, and responsible for managing the accounts and authorizing payments.
Serves as the primary institutional contact for the Practitioner Credentialing Database and responsible for managing the account and authorizing payments.
Responsible for the process of monthly reconciliation of departmental expenses.
Collaborates with various national and state leaders and associations and attends educational seminars and conferences to remain current with best practices, evolving standards, and current and new technology and service options that enhance the efficiency of business processes and improve employee productivity.
Collaborates with ISD Security and Privacy Offers to ensure compliance with all standards and policies.
Oversees and manages a department in the range of 50 staff. The staff positions include Credentialing and Payer Enrollment Managers, Administrators, and Coordinators in addition to an Assistant Director of IT Systems, IT Application Administrator, and Customer Technology Specialists.
Recruits and supervises qualified staff to accomplish departmental operations and functions.
Responsible for thoroughly assessing performance and processes and identifying areas of opportunity for improvement of processes and utilization of resources.
Directs the performance evaluation process for all department staff.
Responsible for thoroughly assessing performance and processes and identifying areas of opportunity for improvement of processes and utilization of resources.
Develops and implements retention strategies such as team building and employee recognition.
Collaborates with the LEAN Performance Improvement Office on various activities within the department and throughout the system.
Develops and implements tools and policies to support knowledge management, record keeping, and internal and external communication.
Directs the process for enrolling all UR Medicine affiliated hospitals’ credentialed practitioners in URMC’s self-insured professional liability (malpractice insurance) program, MCIC Vermont.
Collaborates with internal departments, including operations, contracting, and revenue cycle to ensure alignment in credentialing processes
Collaborates with internal departments to streamline processes and improve communication regarding clinician credentialing
Resolves the most complex problems that arise from time to time, related to credentialing
Direct oversight of the “Proxy Credentialing” functions and agreements associated with URMC’s contracted Telehealth services.
Acts as the Subject Matter Expert (SME) for URMC and the UR Medicine-affiliated hospitals for credentialing processes and systems, providing guidance and support to internal stakeholders to ensure compliance and efficiency including but not limited to administrative leadership, department chairs and division chiefs, department administrators, and the SMD Dean’s Office.
Directs and represents the Medical Staff and Leadership on various hospital and leadership committees including: Credentials Privilege and Review Committee (Direct/Lead) Executive Credentials Privilege and Review Committee (Direct/Lead) UR Medicine System Medical Staff Bylaws Committee (Direct/Lead) SMH Clinical Council Committee (Participate in) URMC Employee Health Committee (Participate in) URMC Privacy & Security Education Committee (Participate in) TJC Steering Committee (Participate in) Telehealth Operations Committee (Participate in) SMH Joint Meeting for Quality-of-Care Board (Represent MSS) SMH Medical Executive Committee (Represent MSS) HH Medical Executive Committee (Represent MSS) UR Medicine Compliance Committee (Represent MSS). UR Medicine System Quality Meeting (Participate in)