Credentialing & Privileging Manager

Bethesda, MD, United States

MicroHealth is seeking a Credentialing & Privileging Manager to support our DHA NCR Network HQ Medical Affairs Clinical Quality Management Program Management Services contract providing patient safety guidance, clinical reviewing current practices and making recommendations on best practices for healthcare using health care data analytics.

This position will report onsite at Bethesda MD

Responsibilities Manage, analyze, evaluate, design/coordinate, and continually improve the health care providers’ Credentials Review and Privileging Program. Serve as the primary interface with hospital credential staff and HQ department and division heads, professional staff, and provides a consultative interface

Receive and assess providers’ credentialing packages and conduct research on the medical education and training of providers requesting clinic privileges

Analyze healthcare material for appropriateness, continuity, and authenticity.

Review contractor verifications to determine the adequacy of investigation outcomes, as well as company compliance to the credentials review portion of the contract. Return unsatisfactory submissions and determine if any resulting delay warrants the interruption of workflow perform the missing verifications locally.

Track, monitor, and register all physicians (military/civilian) for Federal Drug Enforcement Agency Number for multiple hospitals.

Develop and execute system and personal trend monitoring mechanisms to identify, track, and resolve credential issues that directly impact credentials, files, and the provision of quality patient care.

Ensure backup manual tracking systems are in place for all providers in matters relative to the Credentials Review and Privileging Program in the event the computer system fails.

Review staff appointments and clinical privileges status. Review performance appraisal reports for healthcare providers in conjunction with the Performance Improvement Program and the clinical staff reappointment process. Assist with all healthcare provider and transfers to another command, retires, or is released from active duty, ensure the proper disposition of the individual files is accomplished according to HQ guidance

Identify leadership areas of concern, prepare monthly credentials agenda and Credentials and Privileging Activities Reports, and distributes monthly Credential Provider report prior to meeting, which prepared for review, signature, and endorsement.

review, signature, and endorsement. • Provide technical expertise and procedure guidance on the Credential Review and Adverse Privileging Program Fair Hearing Process, conducting all research and preparatory functions in support of the process. Complete all communication requirements inherent in the Fair Hearing process.

Knowledge ofthe operation and use of the clinics database, such as Centralized Credential Quality Assurance System (CCQAS).

Analyze and assure verification in accordance with guidance/standards established by higher authority, all information relative to the medical education and specialized training of clinicians, nurses, and allied health specialist at the clinic. Uses this information to establish provider's bona fine medical expertise prior to their employment at the facility. Coordinate this verification process with various agencies, organizations, and institutions worldwide, both in the Federal and civilian sector.

Study current systems and directives to design/revise the process of establishing, maintaining, and disposing of individual credentials files and individual professional files according to current requirements.

Use medical background and analytic ability to determine the pertinence of requirements that pertain to specific provider categories. Research, analyze, collate, and prepare a variety of monthly and quarterly reports required by Senior Leadership Ensure completion of local performance appraisal reports for placement in Individual Credentials File and Individual Professional File as required by higher authority.

Required Qualifications:

BachelorDegree must be obtained through an accredited institution

5 years of experience in healthcare organizations including credentialing and privileging

Knowledge of military healthcare business rules, operations, and needs.

Ability to analyze workflow, healthcare data, and business processes in organizations.

Ability to evaluate programs for risk, price, operations, and related impacts.

Current (1 – 3 years) knowledge of healthcare high-reliability organization principles and transformation

Expert written and verbal communicator

Familiarity with MHS Healthcare Information Systems and Technology

Current (1 – 3 years) knowledge and experience of current MHS Governance construct and procedures

Physical Demands:

While performing the duties of this job, the employee is regularly required to sit. The employee frequently is required to walk; use hands to finger, handle or feel; reach with hands and arms; and talk or hear. The employee is occasionally required to stand. The employee may lift or move objects up to 5 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, and ability to adjust focus.

MicroHealth will recruit, hire, train, and promote persons in all job titles, and ensure that all other personnel actions are administered without regard to race, color, religion, sex, sexual orientation, gender identity, genetic information, national origin, disability, or status as a protected veteran and ensure that all employment decisions are based only on valid job requirements.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. If you need a reasonable accommodation due to a disability for any part of the employment process, please send an e-mail to [email protected] with your request and contact information.

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