Medical Staff Credentialing Director is responsible for all aspects of the verification process for medical staff incumbents. Provides regulatory oversight and guidance to the credentialing process. Being a Medical Staff Credentialing Director maintains working knowledge and ensures continuing compliance with state, federal, and institutional standards and guidelines. Develops and implements policies and protocols related to medical staff verifications and ensures that the organization and staff are in accordance with organizational and industry standards. Additionally, Medical Staff Credentialing Director analyzes reports on applications and credential status to identify trends and improve the credentialing process. Presents files to the credentialing committee and may act as a liaison to state medical licensure boards regarding the status of license applications. Requires a bachelor's degree. May require Certified Provider Credentialing Specialist (CPCS). Typically reports to senior management. The Medical Staff Credentialing Director typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. To be a Medical Staff Credentialing Director typically requires 3+ years of managerial experience. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. (Copyright 2024 Salary.com)
Northern Light Eastern Maine Medical Center
Department: Medical Staff Administration
Position is located: Northern Light Eastern Maine Medical Center
Work Type: Full Time
FTE: 1.0 (40 hours per week)
Work Schedule: 8:00 AM to 4:30 PM
1. GENERAL POSITION SUMMARY : Responsible for planning and managing the human, material, equipment and fiscal resources for areas of responsibility and accountable for developing action plans to contribute to the organization’s ability to carry out its mission and accomplish annual pillar goals.
2. SPECIFIC POSITION SUMMARY: Provides direction and leadership for:
Support the Credentialing and Privileging Staff of the Medical Staff Office and the Chief of Service Support Staff for the Services of Anesthesia, Cardiovascular, Emergency Medicine, Family Medicine, Medicine, Ob/Gyn, Orthopedics, Pathology, Pediatrics, Psychiatry, Radiology, Surgery, and Rehabilitation.
Provides support for the Medical Staff President, including but not limited to, Medical Staff committees and meeting, miscellaneous ad hoc committees, hearing committees, and committee membership, etc.
Responsible for overseeing credentialing and privileging of providers at NL EMMC, Medical Staff Bylaws, policy development of policies that pertain to the medical staff and management of those policies including updates, medical staff interdepartmental directives, and assuring the medical staff regulatory requirements.
Responsible for the professional service budgets for cardiovascular, family medicine, medicine, ob/gyn, orthopedics, psychiatry, radiology, rehabilitation and surgery.
Responsible for assisting the Senior Physician Executive in his/her duties related to aspects concerning the medical staff.
3. GENERAL MAJOR DUTIES AND RESPONSIBILITIES:
Essential functions are identified by an asterisk.
A. Responsible for safety*
1. Insures that the department environment is free from recognized hazards that create a risk of injury to healthcare workers, patients and/or visitors.*
2. Supports and facilitate open and non-punitive communication between healthcare workers, patients and families regarding clinical and environmental safety on their unit and when interfacing with other units, groups and individuals.*
3. Supports and facilitate employee and non-employee healthcare workers in reporting and directly and addressing patient and environmental safety concerns.*
4. Accountable for accident/injury prevention and investigation including root cause analysis, as well as assisting in the return of injured workers to gainful employment.*
B. Maintains excellence in customer services through measurement and improvement action plans.*
C. Ensures the efficient and effective operations of processes in the delivery of service/care for areas of responsibility.*
D. Accountable for budgeting and financial performance.*
E. Monitors compliance with legal and accrediting requirements related to areas of responsibility
functions and services.*
F. Engages staff in providing and improving service delivery.*
G. Recognizes staff and others for contributions.*
H. Commits to assist in EMMC achieving its Equal Employment Opportunity and Affirmative Action goals.*
I. Conducts ongoing high, middle, and low performer conversations with direct reports including appropriate follow up. Holds direct reports accountable for same with subordinate leaders and staff.*
J. Creates a self-development plan to improve leader skills, competence, and outcomes.*
4. SPECIFIC MAJOR DUTIES AND RESPONSIBILITIES :
Essential functions are identified by an asterisk.
Medical Staff Office:
Credentialing and Privileging*
Coordinates and oversees a consistent, thorough, compliant, and exemplary credentialing and privileging of providers. Responsive to the Medical staff President, the Senior Physician Executive, and the other stakeholders in the credentialing and privileging processes including CPDM, human resources, legal, compliance, and System Leadership.
Coordinates and oversees the reappointment processes for providers.
Performs Review and Analysis
Reviews and elevates red flag issues to appropriate parties
Medical Staff Office Staff Supervision
Execute personnel actions, having the authority to hire, fire, transfer, suspend or
otherwise discipline and appraise employees.
Responsible for completing employee evaluations in a timely manner.
Maintain and coordinate attendance records and incidental personnel activities for the
medical staff office.
Supervise assigning duties to office staff.
Responsible for organization and maintenance of personnel files for the professionals of
the medical staff office.
Chief of Service Staff Supervision*
otherwise discipline and appraise employees.
medical staff office.
Establishes a collegial collaborative environment that supports the needs of the staff and the Chiefs of Service.
the medical staff office.
Oversees Departmental Budgets
Provides Miscellaneous Support for Senior Physician Executive *
- Responsible for developing and implementing various initiatives and processes as defined by the Senior Physician executive; e.g. include immunization requirements and tracking and maintenance, allied scientist appointment process, procedural sedation training/competency, implementation and maintenance, disaster call down process - new - implementation and maintenance , etc.
Physician/Allied Health Lounge *
miscellaneous inventory.
Senior Physician Executive.
Support for the Medical Staff President and Medical Staff*
Medical Staff Committees *
Coordinates and provides support for assigned medical staff committees - Budget, Executive, Medical Staff, Nominating and Miscellaneous Ad Hoc Committees *
dietary, AV, etc.
correspondence and related committee documents.
Medical Staff Bylaws *
appropriate personnel and maintaining electronic version on the EMMC Medical Staff
Office webpage.
Miscellaneous *
Responsible for ongoing review of licensing regulations (TJC and CMS) and working with the SPE and other hospital personnel in assuring that the Medical Staff Bylaws and Medical Staff functions, policies & procedures comply with the regulations.
Represents NL EMMC and the MSO in meeting with /complying with outside legal and regulatory bodies and their requests.
Represents and participates NL EMMC on state and other regional boards and/or educational activities to maintain up to date knowledge and teach back to the Medical Office Staff.
Webpage
Maintain EMMC Medical Staff Office webpage
Serve on miscellaneous EMMC and EMHS committees as needed, e.g.
HR Function Team
Physician Appreciation Team
EMHS Echo Users' Group
5. TECHNICAL REQUIREMENTS :
In depth knowledge of working with computer programs currently used for credentials, leadership (e.g. budgeting, payroll) and Microsoft Office (Word, Excel, Access, Powerpoint).
6. SPECIAL SKILLS:
Leadership and management skills, credentialing and privileging processes, knowledge of regulations related to hospital licensing requirements.
7. EXPERIENCE/EDUCATION REQUIRED :
Bachelor's Degree
Has completed or will complete when eligible to sit for the exam, at least one type of certification from the National Association of Medical Staff Services, such as Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM). This requirement must be completed no later than 6 months from eligibility to sit for the exam if not currently certified.
8. EXPERIENCE/EDUCATION PREFERRED :
Master's Degree
At least 3 years in a leadership position.
Current CPMSM certification from the National Association of Medical Staff Services
9. LICENSES OR CERTIFICATIONS : None
10 . PHYSICAL ENVIRONMENT (If the demands of the position are any other than a typical
office/clinical setting):
Position is initially on-site full time. May transition to hybrid as appropriate while still supporting necessary on-site time and support needs with approval of the SPE and the VP of HR.
11. PHYSICAL DEMANDS:
Light to medium carrying up to 50 lbs., straight pulling/pushing, reaching in all directions, stooping, walking long distances, standing, sitting, repetitive motion/finger activity for sustained periods of time, speaking, hearing, moderate phone contact, visual activity; long periods of working on computer.
12 . SUPERVISES:
Titles of direct report leaders, number of staff 6 (six)
13. REPORTS TO: NL EMMC Senior Physician Executive
Responsible to the Director of Credentialing Provider Data Management (CPDM) for NLH System level changes and alignment. Regular report out and consultation required.
Works in alignment with NL EMMC Human Resources, NL Legal Department, the Northern Light System Bylaws and Northern Light VP Medical Group Operations.
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