Medical Staff Credentialing Specialist, Sr. jobs in Portland, ME

Northern Light Mercy Hospital

Department: Medical Staff Administration

Position is located: Mercy Fore River

Work Type: Full Time

FTE: 40 Hours per week

Work Schedule: 8:00 AM to 4:30 PM

Summary:

The Medical Staff Specialist will work in conjunction with the Medical Staff Manager to plan, review, and develop various Medical Staff Programs as they relate to privileging/credentialing and provider relations. Serves as an essential link between hospital administration and the Medical Staff to promote and enhance communication and to create a positive working relationship. Ensures adherence to regulatory requirements and accreditation standards relevant to the organized Medical Staff. Maintains a working knowledge of applicable statutes and laws. Develops, directs and evaluates programs, services and activities related to Clinical Library Services, Continuing Medical Education, and Graduate Medical Education. Provides leadership in the development and maintenance of the electronic delivery of information to and concerning the Medical Staff. Facilitates selected projects for the Medical Staff such as Focused Professional Practice Evaluation and Ongoing Professional Evaluation. Interacts with external customers such as regional and corporate colleagues with credentialing responsibilities, licensing officials and regulatory bodies. The incumbent may have access to highly confidential patient, employee and/or proprietary information, and must handle and protect the information in accordance with hospital and system policies, HIPAA requirements and the highest level of ethical standards. The incumbent is responsible for reporting all security events, potential events, or other security risks to the organization. The incumbent is responsible for participation in and completion of all patient safety initiatives appropriate to the position, and conducts all job responsibilities according to the Mission and Values of the Hospital.

Responsibilities:

• Communicates and enforces the system-wide Corporate Compliance program for Mercy Health System of Maine.
• Reports any potential or real ethical, legal or regulatory violations to the Corporate Compliance Officer.
• Encourages staff to report Corporate Compliance issues either directly or through the Mercy Compliance Line (may be anonymous).
• Assists with investigations into alleged violations, and the development and implementation of disciplinary and/or corrective action as indicated.
• Continually assesses the department for compliance with all federal, state, local and other regulatory (The Joint Commission, OSHA, CMS etc.) requirements.
• Completes annual staff training, ensuring staff understanding of participation in the above
• Supports Mercy’s mission by working to ensure the level of regulatory compliance essential to achievement of organizational goals.
• Actively participates in developing, maintaining, and creating an organization united by a commitment to the Mission and Values of Mercy and characterized by open, honest communications and respect for the dignity of the person.
• Utilizes Mission-based considerations in the use of human, financial, and material resources and in planning for future services to those served by Mercy Hospital.
• Participates in developing and maintaining processes to ensure that Mercy’s Values are visibly reflected in all aspects of organizational life.
• Is responsible for ensuring that the initial and/or reappointment process is performed within Joint Commission standards, Maine State hospital licensing regulations and any other relevant regulations.
• Manages and administers all Mercy Medical Staff credentialing/privileging operations and related monitoring programs for initial and/or reappointments. Activities within this function include but are not limited to assignment of work responsibilities, regular communications with CVO staff to review applications in process, identifying issues, and facilitating resolutions.
• Serves as a facilitator between the Division/Department Chiefs and each initial and/or reappointment applicant, including but not limited to, providing appropriate documentation relevant to privilege requests, provide supporting documentation to enable recommendation decisions, and serving as the liaison between the Chiefs and applicant when questions arise.
• Assists in evaluating problematic provider applications and provides appropriate guidance to staff and physician leaders. Informs the Medical Staff Manager as well as the SPE of key credentialing issues for credentialing applications to provide awareness and to achieve commonality for resolution if necessary. Presents regular reports to the Medical Staff and Board of Trustees on all credentialing/privileging matters. Is responsible for the accuracy and integrity of the data entered and stored within the credentialing electronic database and provider dictionary for the hospital clinical information system. Develops and maintains reports from the database for both internal and external requirements as needed.
• Assists in evaluating and bringing forth recommendations for the appropriate method to accomplish credentialing activities. Evaluates outside contracts and facilitates discussions with contract leadership to maximize cost and benefits of the relationship.
• Helps maintain practitioner roster information on the hospital-wide information system database to identify medical staff members and their clinical privileges for use as appropriate by clinical personnel of the hospital.
• Researches and creates new privileging criteria and related credentialing protocols.
• Serve as primary enrollment coordinator for all practitioners to utilize electronic prescribing per State of Maine mandates. Participates in the planning and organizing of a comprehensive specialized program for Medical Staff Services to assure continued accreditation by the Joint Commission and licensure by the State of Maine and to assure excellence in patient care and Medical Staff Quality
• Interprets, explains, and follows all regulatory guidelines involving the Medical Staff, including those by the State of Maine, Joint Commission, federal guidelines, and Medical Staff Bylaws.
• Implements established policies and procedures.
• May be required to develop certain policies, making recommendations to the appropriate Medical Staff Committees. Develops, directs and evaluates programs, services and activities related to clinical library services.
• Assesses the information needs of a diverse array of medical and health services professionals and manages the selection, acquisition and use of health information resources.
• Promotes current available health information resources through frequent communication with clinicians and staff.
• Provides leadership that result in completion of literature searches and acquisitions of new materials.
• Manages library budget. Makes adjustments related to clinical work of the system. Medical Student and Resident Rotation Coordination
• Is the designated contact person for all medical students/residents/fellows/and clinical coordinators to set up a rotation through the hospital.
• Responds to all student inquiries regarding rotations.
• Communicates with the students/residents and appropriate parties to inform them of the requirements to begin a rotation as well as identifies physicians and practices that accept students.
• Maintains appropriate tracking systems of all students/residents/fellows.
• Organizes and collects all required documentation.
• Facilitates badge and system access for students/residents/fellows.
• Tracks, creates and amends affiliation agreements between the hospital and institutions. CME
• Ensures that certification guidelines of the Maine Medical Association’s Accreditation Council for Continuing Medical Education (ACCME) are met.
• Provides guidance to educational sponsors of CME activities. Interprets guidelines regarding such areas as commercial support, disclosures of conflict of interest, appropriate sponsorship and compensation for speakers.
• Reviews all CME application submissions for ACCME compliance.
• Maintains and updates all tracking documents for CME activities. Processes credits and provides certificates to CME learners.
• Compiles and maintains documentation of each Category 1 CME hospital sponsored program.
• Prepares CME Category 1 annual report and completes a self-study at the time of regular program audit by the MMA ACCME.
• Is the primary staff person designated for the CME Committee. Coordinates the meeting preparation, invitations, agenda and minutes and clearly communicates such to all CME Committee members.
• Works collaboratively with the CME Medical Director.
• Attends the CCMEA Annual Meeting for CME Coordinators/Administrators.
• Performs compliance monitoring of CME events. 6. Medical Staff Office Functions

• Collaborates with Medical Division Chiefs and Department Chairs to set, review, and maintain OPPE goals and thresholds.

• Provides leadership in the process for on boarding of new providers. Periodically evaluates and adjusts the program.

• Fosters a culture of Medical Staff recognition and collegiality through a series of special events.
  

Other Information :

Competencies and Skills

• Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.
• Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of diversity, inclusion, empowerment and cooperation.
• Demonstrates Adaptability: Learns quickly when facing a new problem or unfamiliar task; is flexible in their approach with changing priorities and ambiguity. Manages change effectively and does not give up during adversity. Capable of changing one's behavioral style and/or views in order to attain a goal. Absorbs new information readily and puts it into practice effectively.
• Effectively Communicates: Listens, speaks and writes appropriately, using clear language. Communication methods are fitting to the message(s), audience, and situation and follow-ups are regular and timely. Shows that important (non-) verbal information is absorbed and understood and asks further questions to clarify when necessary. Expresses ideas and views clearly to others and has ability to adjust use of language to the audiences' level.
• Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.
• Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.
• Utilizes Resources Effectively: Understands how to get the most out of available resources and uses cost-benefit thinking in decision-making and in setting priorities. Monitors and analyzes resource usage to identify and eliminate areas of waste and maximize resources. As a leader, defines targets and provides appropriate means; oversees progress and makes adjustments when necessary. Appropriately delegates work, sets clear direction and manages workflow and time.

Working Conditions

• Potential exposure to abusive and/or aggressive people.
• Work with computers, typing, reading or writing.
• Lifting, moving and loading less than 20 pounds.
• Prolonged periods of sitting.