Supervisor, Credentialing Services (PMG)

Kaiser Permanente • Pasadena, CA

76d

About The Position

The position involves supervising a team responsible for reviewing and requesting primary source information and verifications. The role requires proactive identification and suggestion of improvements to vendor relationships, serving as an escalation point for external queries regarding practitioner status, and evaluating applications and supporting complex documents. The supervisor will guide the team in improving credentialing and privileging processes, evaluate complex practitioner sanctions, and participate in surveys and audits of credentialing entities. The position also includes facilitating strategic initiatives for cost-effective due process, resolving adverse actions, and leading audits of data across departments. The supervisor will conduct training for newly appointed physician leaders and maintain relationships with key stakeholders while ensuring compliance with current policies and regulations.

Requirements

• Bachelor's degree in Business Administration, Health Care Administration, Nursing, Public Health, or related field.
• Minimum five (5) years of experience in clinical credentialing, accreditation and regulation, licensing, health care, quality, or a directly related field.
• Minimum eight (8) years of experience in clinical credentialing, accreditation and regulation, licensing, or a directly related field.
• Minimum two (2) years of experience in a leadership role.
• Minimum two (2) years of experience with databases and spreadsheets.
• Professional Medical Services Management Certificate or Provider Credentialing Specialist Certificate.

Nice To Haves

• Knowledge of negotiation and compliance management.
• Experience in health care data analytics.
• Skills in project management and risk assessment.
• Familiarity with health care quality standards and credentialing IT application software.

Responsibilities

• Supervise team to review and request primary source information and verifications.
• Identify and suggest improvements to vendor relationships.
• Serve as an escalation point for external queries regarding practitioner status.
• Evaluate applications and support complex documents.
• Guide team to improve credentialing and privileging processes.
• Evaluate complex practitioner sanctions.
• Participate in surveys and audits of credentialing entities.
• Facilitate strategic initiatives for cost-effective due process.
• Resolve adverse actions/issues.
• Lead audits of data between different departments.
• Conduct training for newly appointed physician leaders.
• Develop complex informational documents.
• Maintain working relationships with key stakeholders.
• Facilitate meetings with leadership to develop onboarding processes.
• Supervise team to process complex provider enrollment information.
• Ensure team completes communications of relevant information.
• Supervise team to control data systems and applications.
• Supervise team to ensure credentialing data analyses.
• Review multiple types of database structures and data.
• Communicate status and lead development of corrective action plans.

What This Job Offers

• Career Level: Mid Level
• Industry: Ambulatory Health Care Services
• Education Level: Bachelor's degree