Medical Staff Credentialing Director jobs in Las Cruces, NM

General Description:  

The Medical Staff Services Director is responsible for leadership, management and operational oversight of the medical staff support services that includes Medical Staff credentialing and privileging, peer review, provider payer enrollment, CME program management, maintenance of the Medical Staff Bylaws, Rules and Regulations and policies, practitioner recruitment and retention, and meeting management, all within the requirements of the Medical Staff Bylaws, GRMC organizational policies and regulatory agencies.  S/he supervises the staff and the daily operations of the Medical Staff Services Department, serves as a liaison between the Medical Staff and GRMC Departments, and assists in interpreting Medical Staff Bylaws, Rules and Regulations,  policies, procedures and services as relates to the Medical Staff.

• Responsible for maintaining compliance with applicable regulatory agencies, i.e., Centers of Medicare/Medicaid (CMS), The Joint Commission (TJC), federal and state regulations, medical staff bylaws, rules and regulations and hospital policies and procedures related to the medical staff.
• Oversees the Practitioner Peer Review Program, assessing the quality of care provided to our patients, while ensuring that the functions satisfy on-going changes in regulatory requirements. Processes all complaints suggestive of impaired or unethical conduct by practitioners; oversees the process for investigation and fair hearing, according to the Bylaws.
• Coordinates with Quality Department to facilitate both Ongoing Professional Practice Evaluations (OPPE) and Focused Professional Practice Evaluations (FPPE).
• In coordination with the Risk Department, ensures timely and proper notification of any probable claims involving peer reviewed cases.
• Prepares reports for various physician committees, related to quality review activities, utilization, impairment, relationship difficulties, or other areas as may be deemed appropriate.
• Coordinates implementation of all approved programs, projects and major activities of the Medical Staff.
• Oversees and directs the credentialing and privileging process for the practitioners, ensuring the program is in compliance with all regulatory agencies.  Attends the Credentials Committee and oversees credentialing reporting to the Medical Executive Committee to ensure on-going compliance is maintained for all practitioners at all times.
•  Oversees the recruitment and the retention of the practitioners, including orientation. in conjunction with the Board of Trustees.  Provides statistics for the GRMC planning process to determine the physician needs in the community
• Negotiates and oversees physician contracts and income guarantees.
• Oversees the Continuing Medical Education (CME) Program, ensuring compliance with New Mexico State Medical Society and Accreditation Council for Continuing Medical Education (ACCME) regulations for CME presentations.
• Coordinates the development and maintenance of the Physicians’ Lounge, including furniture, food items and supplies.
• Oversees the content and production of the Physician Newsletter, portal and the practitioner pages of the GRMC web site.  
• Coordinates and serves on various medical staff committees such as the General Medical Staff, MEC, etc. Prepares agendas and packets, minutes, etc.  Works with the medical staff Bylaws Committee Chair to update and maintain the medical staff Bylaws, Rules and Regulations.
• Oversees the practitioner call schedule program.  
• Prepares departmental budget and monitors and controls operational expenses within approved budget.
• Supervises caregivers in the Medical Staff Services Department.  Establishes goals and objectives, provides feedback and evaluates performance, counsels and develops caregivers.
• Supports the Chief of Staff, Chiefs of Departments, Chief Medical Officer and Committee Chairs in the context of their roles and responsibilities.
• Utilizes computer software program(s) necessary to support the credentialing process and manages the centralized provider database that includes data entry and scanning of appropriate documents directly into the database.
• Responsible for overseeing and managing the provider payer enrollment process which includes ensuring providers are enrolled in insurances timely and accurately, updating and monitoring provider CAQH accounts, maintaining the organization’s payer enrollment matrix,  monitor pending enrollment and/or acknowledge all documents are received and ensures communication with insurances are done in a timely manner.

Education/Experience

• Minimum Bachelor’s Degree or actively enrolled in a healthcare Bachelor’s Program
• Must obtain NAMSS CPCS certification within 18 months from hire date into position
• Extensive clinical background and familiarity with hospital practices, medical terminology, various patient diagnoses, levels of care, patient care areas, and medical records.
• Skilled in the application of basic statistical processes, data analysis and reporting.
• Proficiency with computer programs including word processing, and spreadsheets for the purpose of tracking occurrences and trends.
• 3 years experience in Medical Staff
• Ability to maintain confidentiality is imperative.
• Ability to interact effectively with front line caregivers, practitioners, board members and administration.
• Experience in credentialing and working with physician issues

NOTE:  Job description available on request.

**All required documents must be presented at time of hire.**

EXTERNAL APPLICANT:  Employment is contingent upon successful completion of pre-employment drug and alcohol testing.

GRMC is an Equal Opportunity Employer.