Accountable for the delivery of management, consultation and facilitation services which provide support to the Medical Group, Region, Division, MSA's, medical centers, medical offices and other identified sites for credentialing and privileging issues. Accountable for systems and quality improvement processes that ensure compliance with the Regional Credentials Policies and Procedures, the Program Office, regulatory and accrediting agencies', as well as internal credentials requirements.
Essential Functions:
- Upholds Kaiser Permanente's Policies and Procedures, Principles of Responsibilities and applicable state, federal and local laws.
- Directs, manages and facilitates the design, development, coordination and quality of the credentialing process.
- Creates operations and communications processes that support organizational strategies and business objectives.
- Provides consulting services regarding regulatory, legal, accreditation, Program and Regional Credentialing and Privileging standards throughout the region.
- Manages the credentialing budget.
- Directs the credentialing function as required.
- Hires, trains and supervises all credentialing staff as required.
- Creates and manages credentials budget, as required.
- Directs and facilitates with practice site Medical Staff Coordinators to implement best practices whenever feasible.
- Interprets requirements and disseminates information to all involved parties to assure necessary compliance, compatibility and continuous quality improvement of credentialing processes.
- Conducts on site audits, coordinates action plans with sites to ensure compliance with all standards. Informs Medical Group and KFH/P leadership of key issues acts as a Medical Group agent in influencing changes in Program and agency requirements.
- Partners with appropriate Program, Region, MSA, Medical Group individuals and groups, accrediting bodies and external consultants to develop and implement systems and processes that meet requirements and adhere to Regional Credentialing and Policies and Procedures.
- Collaborates with interregional peers to identify and implement best practices.
- Assume other activities and responsibilities from time to time as directed.
Qualifications:
THIS IS A REPOST OF 153950.
Basic Qualifications:
- Bachelor's Degree or equivalent experience required.
- Certification in a health care related field (CPHQ or CMSC).
- A minimum often (10) years of experience in health care in both an administrative and/or managerial position.
- Experience with accreditation agencies, such as: The Joint Commission, NCQA, Medicare, DMHC and CMS required.
- Expert experience with by-laws.
- Past experience of system and process improvements that shows forward thinking ability, initiative and vision.
- Expert knowledge of the credentialing process and accreditation and regulatory standards.
- Proficient in Medical Terminology.
- Demonstrated problem-solving skills, consulting skills in the area of Credentialing and associated regulations.
- Thorough understanding of metrics and reporting out of the Medical Staff Office environment.
- Ability to lead and facilitate processes through influence and collaboration.
- Significant knowledge of Federal and State Regulatory requirements and accreditation standards.
- Strong organization and communication skills, attention to details required.
Preferred Qualifications:
- Master's Degree preferred.
- Minimum two (2) years of experience in a related clinical setting (nursing, medical records) preferred.
Notes:
- May travel (5%).
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.