Develops, manages, and supervises the credentialing functions for Medical-Dental Staff Services. Analyzes and evaluates primary source verification data and documents for initial appointments and reappointments to the Medical and Dental Staff according to hospital and outside regulatory standards (Joint Commission, Centers for Medicare and Medicaid Services (CMS), etc, for both hospital credentialing and privileges. In collaboration with Delegated Credentialing Coordinator manages data quality and integrity for web-based applications based on defined standards through systematic audits. In collaboration with Clinical Review Manager, Leads and manages the practitioner performance evaluation process in accordance with Joint Commission Standards and Medical Staff Bylaws. Partners with Medical and Dental Staff Leaders to develop policies, evaluation standards, and privilege forms based on regulatory changes or hospital service changes.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
Plans, organizes, leads, and directs Medical Staff Services team activities; appropriately addresses staffing needs, hires, and trains, evaluates, coaches, and manages the team, including establishing goals and objectives for the development of departmental human resources.
Prepares, tracks, and manages fiscal budget and restricted account.
Ensures accuracy of system-wide process for distribution of clinical privileges to numerous internal clinical service areas. Maintains data integrity, generates and analyzes scheduled periodic quality reports, provides standard and specialized reports to customers, and process improvement/quality feedback to staff.
In collaboration with Corporate Director, works in concert with legal counsel and medical staff leadership to facilitate amendments to medical staff governance documents to ensure compliance with regulatory, statutory, legal, and accreditation bodies and their required standards, as well as with medical staff bylaws, policies/procedures, and rules & regulations for all facilities.
Exhibits and promotes within the Medical Staff Services department excellent customer service to medical staff leaders, medical staff members, medical staff applicants, hospital administration, and internal and external customers.
Develops and implements all credentialing and privileging processes and procedures for all physicians and mid-level practitioners, including establishing qualifying criteria for initial appointment.
Educates team members on organizational objectives and ensures their understanding of the team's part in meeting those objectives.
Processes applications in a timely fashion analyzes data, identifies red flags, and items requiring further review/additional information for assigned department
Maintains accuracy of medical staff database using consistent language for accurate reporting
Maintains current status for licensure, DEA registration, certifications, and professional liability insurance
Utilizes resources effectively, while maintaining costs associated with credentialing
Appropriately interprets Joint Commission, CMS, and other regulatory standards and applies this information to the credentialing and privileging process
Maintains open communication with applicants and Medical Staff leaders.
Maintains mechanism for communicating medical staff demographic and privilege changes within the organization
Prepares agendas for, attends, and records minutes for assigned meetings. Follows up as required
Demonstrates knowledge of regulatory standards that pertain to credentialing
Interacts with physician medical staff leadership, senior leadership, and other departments to develop and promote the physician led quality strategy for the organization.
Provides support to Advanced Practice Nurses (APN) within the Christiana Care Health System through participating in and promotion of the professional interests of APNs including credentialing and privileging processes.
Provides clinical expertise for initial and renewal credentialing for all employed and non-employed specified health professional APNs and revisions to clinical privileges and job descriptions.
Prepares and maintains credential files for presentation through the approval process.
Develops and maintains the SharePoint site for the committee
SCOPE, PURPOSE, AND FREQUENCY OF CONTACTS:
Provides on-going contact with members of the Medical Dental Staff, administration, and legal counsel to assure maintenance and enhancement of effective relationships between the medical community, administrative personnel, ancillary departments, and patients of Christiana Care
DIRECTION/SUPERVISION OF OTHERS:
Provides direct supervision of the Medical Dental Services department and staff
Corporate Director Medical, Office of Chief Clinical Officer
EDUCATION AND EXPERIENCE REQUIREMENTS:
Bachelor degree in Business Administration or a related field
Five (5) years' experience in Medical Affairs office with a minimum of one (1) year management experience
An equivalent combination of education and experience may be accepted
KNOWLEDGE, SKILL, AND ABILITY REQUIREMENTS:
Supervisory principles and techniques
Knowledge of clerical methods and office equipment
Knowledge of medical-legal issues and laws, all regulatory agency requirements and standards
Knowledge of budgeting and finance management
Knowledge of the Medical Staff Credentialing system
Ability to analyze administrative problems and make appropriate recommendations
Interpersonal and management skills
Excellent oral and written communication skills
Independent problem solving skills, decision making ability, flexibility, perseverance, and fortitude
CPCS certification preferred.
Active member of the National Association Medical Staff Services (NAMSS) or other professional organization related to credentialing verification preferred.
Frequent sitting, standing, and walking
Generally pleasant office environment
Internal Number: 48008BR
About Christiana Care Health System
Christiana Care Health System is headquartered in Wilmington, Delaware and is one of the country's largest health care providers, ranking 21st in the nation for hospital admissions. Christiana Care is proudly a Nurse Magnet recognized institution. Christiana Care Health System is also one of the largest health care providers in the mid-Atlantic region, serving all of Delaware and portions of seven counties bordering the state in Pennsylvania, Maryland and New Jersey. A not-for-profit, non-sectarian health system, Christiana Care includes two hospitals with more than 1,100 patient beds, and is a major teaching hospital with two campuses. Christiana Care is continually recognized for excellence on a regional and national level. Our role in the community is expressed in the Christiana Care Way: "We serve our neighbors as respectful, expert, caring partners in their health. We do this by creating innovative, effective, affordable systems of care that our neighbors value."Christiana Care is a great place to work because we value diversity and recognize it to be a core part of our success. Because of the diversity of our employees, affiliated health professionals and volunteers, we are... positioned to meet the unique needs of our patients and community. We acknowledge and celebrate the uniqueness and talent of each employee. Because of our talented workforce we are able to provide a quality healthcare experience to our patients and community. We strive to create an inclusive environment in which individual diversity can be leveraged and thrive. Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.