Director, Medical Staff Administration - 127518

The Director of Medical Staff Administration plays a critical role as a gatekeeper of patient safety within the organization as a technical expert developing, implementing and maintaining policies and procedures governing Medical Staff activities and effective credentialing and privileging practices.

The Director's primary focus is on the oversight of departmental activities to ensure quality in conducting, maintaining, and communicating physician credentialing, privileging, source verifications, database accuracy, appropriate staffing and contractual compliance.

The Director is a technical expert in medical staff credentialing and privileging, and is responsible for overseeing management of medical staff processes including compliance with delegated credentialing agreements for health plan enrollment.

The Director is also responsible for designing and managing the implementation, operations, evaluation and fiscal management of Medical Staff Administration.

Assures compliance with The Joint Commission (TJC), Centers for Medicare& Medicaid Services (CMS), National Committee on Quality Assurance (NCQA), Accreditation Association for Ambulatory Health Care (AAAHC), and applicable state and federal law.

Partners with Office of the CMO, contracted entities, officers of the medical staff, health system leaders, health system legal team, local and regional medical staffs and health care practitioners regarding credentialing, privileging, and medical staff services.

Position involves the development, implementation, and monitoring of effective and efficient systems to facilitate all aspects of medical staff services, including credentialing, privileging, and maintenance of credentialing databases, and operational activities of Medical Staff Administration.

Recognizes potential discrepancies and adverse information, and oversees the investigations and validation of applications, primary source verifications, or other source documentation.

Directs Medical Staff meeting management and follow up for medical staff meetings and peer review activities. Serves as the liaison between the medical staff and all hospital departments to coordinate and provide overall continuity of medical staff activities.

Monitors compliance with medical staff bylaws, rules, regulations, policies and procedures. Oversees the establishment of systems to maintain practitioner data, monitor credentialing processes, complaint resolution, and regulatory compliance.

Accountable for the overall administrative planning and coordination of the staffing, fiscal, and material resources in assigned areas.

Key Responsibilities :

• Oversees the development, planning and organization of the medical staff services functions. Prepares and oversees the monitoring of the department’s operational and capital equipment budgets.
• Interprets and enforces the functions and responsibilities of the medical staff governance structure. Works with clinical services in the review / revision of privileging forms and criteria, and credentialing standards.
• Develops long-term strategic plans and ensures short-term plans are in place for subordinate management.
• Provides leadership on task forces and committees related to medical staff functions and issues. Serves as a resource to both internal and external customers, including School of Medicine departments, Medical Boards, Medical Staff Committees, clinical services, practitioners, including advanced practice professionals, regulatory agencies, medical groups, hospitals, and health plans.
• Assures compliance with medical staff bylaws and other accrediting and regulatory requirements. Participates in audits and surveys relating to accreditation and credentialing compliance.
• Accountable for the overall administrative planning and coordination of the staffing, fiscal and material resources in the Department.
• Oversees and directs delegated credentialing audits with regulatory agencies. Collaborates with other department heads to develop policies and procedures.

Initiates responses to corrective action plans and is accountable for complete resolution to audit recommendations.

• Oversees and coordinates with legal counsel on medical staff investigations, disciplinary actions, judicial reviews, and appeals to ensure compliance with established process.
• Forecasts long term staffing needs. Defines development and growth consistent with workforce planning. Develops core competencies, assessment plans and tools.
• Provides mentorship and leadership to managers and supervisors. Reviews and approves individual leadership / professional development plans, with succession planning needs in mind.
• Other duties as assigned.

MINIMUM QUALIFICATIONS

A Bachelor's Degree in Business Administration, Healthcare Administration, or related field, and eight or more years of relevant experience;

OR an equivalent combination of experience, education and training.

Experience and proven success in external regulations, credentialing best practices, and clinical operations to implement in an acute care setting.

PREFERRED QUALIFICATIONS

• Certified Professional Medical Services Management (CPMSM).
• Certified Provider Credentialing Specialist (CPCS).
• Prior experience managing credentialing and privileging within an Academic Medical Center
• Extensive MSOW Database Experience
• Crystal Report Writing Experience

SPECIAL CONDITIONS

• Must pass a background check.
• Must pass physical, drug screen and TB test.
• Must be able to work various hours and locations based on business needs.

Pay Transparency Act

Annual Full Pay Range : $112,100 - $216,500 (will be prorated if the appointment percentage is less than 100%)

Hourly Equivalent : $53.69 - $103.69

Factors in determining the appropriate compensation for a role include experience, skills, knowledge, abilities, education, licensure and certifications, and other business and organizational needs.

The Hiring Pay Scale referenced in the job posting is the budgeted salary or hourly range that the University reasonably expects to pay for this position.

The Annual Full Pay Range may be broader than what the University anticipates to pay for this position, based on internal equity, budget, and collective bargaining agreements (when applicable).