Medical Staff Credentialing Director jobs in Janesville, WI

POSITION SUMMARY:

Responsible for design, development, maintenance and operations of health system programs and outside contracted entities, for credentialing, medical education and medical staff services. Ensures compliance with NCQA and Joint Commission standards, Center for Medicare/Medicare (CMS), state and federal laws pertaining to credentialing and medical staff. Ensures compliance with Illinois State Medical Society (ISMS) Education and CEU accreditation. Primary liaison between the Chief Medical Officer, Medical Director of StaffCorp Inc, officers of the medical staff, health system leaders, health system legal team, local and regional medical staffs and health care practitioners regarding credentialing and medical staff services. Works directly with legal team and medical staff leaders pertaining to any legal issues involving credentialing actions, and/or disciplinary action of medical staff members or adverse credentialing decisions. Participates in continuous quality improvement activities as well as strategic health system initiatives. Develops and implements business and strategic initiatives ensuring the gold standard of credentialing is retained. Maintains ethics and confidentiality of position. Provides backup to the Chief Medical Officer on credentialing/privileging and other medical staffing issues, as necessary.

EDUCATION/TRAINING:

At least five years progressive management experience in a medical staff service or credentialing setting. Bachelor’s Degree in healthcare administration or related field preferred.

LICENSURE/CERTIFICATION:

Certification as a Provider Credentialing Specialist (CPCS) or Professional Medical Services Management (CPMSM) required. Must retain certification.

EXPERIENCE/SKILLS/ABILITIES:

Demonstrated leadership skills and management skills. Excellent communication, organization and critical decision-making skills required. Extensive working knowledge of health care delivery systems, Joint Commission and NCQA standards, regulatory compliance and state and federal laws relating to credentialing and medical staff services, strong knowledge and understanding of continuous quality improvement and peer review processes, risk management and utilization review processes pertaining to medical staff. Excellent interpersonal skills and ability to effectively interact with Board of Directors, health system legal team, physicians, administrators and all levels of staff within the organization and community. Ability to utilize complex database software, spreadsheets and databases. Successful completion of annual job specific competencies required.