: Assists in the development of policies, procedures and processes to ensure timely and efficient credentialing/recredentialing for KFHP/Affiliated Allied Health Professionals, and CPMG Affiliated/Practitioners in: hospitals, medical offices, surgical clinics, and health plan. Develops and maintains policies and processes to assure full compliance with all federal, state and local statutes, and with Credentialing Committee, JCAHO and NCQA standards. Coordinates the Credentialing Program and assists with assignments among credentialing staff; identifies problems and/or opportunities. Improves credentialing program; devises and implements efficient strategies for gathering, storing, analyzing, reporting and tracking provider information. Leads annual external credentialing audits of contracted affiliated hospitals and entities assuring compliance to Credentialing Committee and NCQA credentials standards. Assigns and distributes workload regarding audits and monitors audit processes. Monitors corrective action plans pertinent to assuring full compliance to credentialing standards. Participates in community credentialing activities/user boards, committees and represents Organizations' audits with external agencies to ensure appropriate credentialing practices. Program Integration: Integrates credentialing processes with credentialing Committee, adjusts review process, conducts audits/reporting with community medical affiliates. Interfaces with quality programs and maintains up to date quality files. Assists in the development of routine and special system reports, provides ad hoc reporting, updates data for integrity and accuracy. Assists in the development of automated personal computer system applications where necessary. Gathers, stores, analyzes, reports and tracks practitioner credentialing information and quality file information. Edits data collection for complete record of credentialing information.
Secondary Functions:
In addition to defined technical requirements, accountable for consistently demonstrating service behaviors and principles defined by the Kaiser Permanente Service Quality Credo, the KP Mission as well as specific departmental/organizational initiatives. Also accountable for consistently demonstrating the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to each other, to our members, and to purchasers, contracted providers and vendors.
Qualifications:
Basic Qualifications:
Two years of hospital or multi-specialty group credentialing experience to include substantial experience in policy development and/or managing compliance processes.
Equivalent experience will be considered.
Knowledge of JCAHO and/or NCQA credentialing standards.
Must be skilled in personal computer applications such as word processing, spreadsheets, and data base management.
Bachelor's degree in business administration, human resources or related area
Preferred Qualifications:
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.