Director, Credentials Verification Organization

Core Responsibilities and Essential Functions

Credentials Functions

• Oversight of credentialing/privileging for Medical Staff, Advanced Practice Professionals and Allied Health Professionals for Wellstar Health System hospitals, Wellstar Medical Group, PHO, Wellstar Clinical Partners and delegated credentialing for managed care organizations.
• Assure application process initiated and completed per Medical Staff Bylaws, the Joint Commission and NCQA standards, CMS and state/federal regulations.
• Analytical responsibility for credentialing information obtained during application process.
• Responsible for maintenance of current, electronic credential file including maintaining current required documents (professional license, DEA, liability insurance, board certification, etc.).
• Oversight of communication with all applicants regarding membership and privileging.
• Assures appropriate interface with Wellstar Legal and Risk Management regarding credentialing.

Regulatory Compliance/Continuous Survey Readiness

• Maintains current working knowledge of all regulations, statutes, laws and accreditation standards that regulate the organized medical staff and the credentialing process.
• Provide guidance and serve as expert resource to the Medical Staff Leadership and organization in these areas.
• Identify the need for amendments to documents such as Medical Staff Bylaws, Policies or Rules and Regulations when required to maintain compliance.
• Responsible for compliance with all appropriate regulatory body standards, state requirements and procedures.
• Demonstrates accurate knowledge of Medical Staff Bylaws, Rules and Regulations, and policies and procedures.
• Coordinates and participates in development and revision of documents to ensure compliance.
• Acts as liaison between Medical Staff and Health System attorneys on medico-legal issues as needed.

Communication

• Serve as liaison between Medical Staff, Administration, Senior Leadership and other Departments.
• Assures customer service by the Credentials Verification Organization.
• Improve and promote communication and teamwork among the various Medical Staff Organizations as well as within the Department and between Medical Staff Services and Medical Staff Leadership, Administration, Senior Leadership and other related Departments.
• Foster team approach between departments in the communication of information related to credentialing and other pertinent support functions.
• Maintains excellent working relationship with Medical Staff Offices and Medical Staff/Allied Health Staff Members.
• Interacts appropriately with internal and external departments (Wellstar Medical Group, affiliated groups, IT, Administration, Board of Trustees, Wellstar Clinic Partners, etc.).
• Responsible for reports to the Medical Staff, Administration, Senior Leadership and other departments as required.

Management/Staff Development

• Creates and maintains a positive work environment.
• Develop, support, and encourage educational opportunities (formal and informal) for Medical Staff Services professionals to promote quality leadership and support services.
• Collaborate with Senior Leadership to define the goals and objectives of the Medical Staff Services Department ensuring alignment with System strategic goals.
• Provide staff with clear expectations, goals, directions and identify areas of opportunity for improvement.
• Oversight of personnel management from recruitment to employee development.
• Interview, hire and orient staff for direct report positions.
• Oversight of Medical Staff Services job performance standards.
• Oversee/assist in performance evaluations. Complete performance evaluations for direct reports.
• Responsible for evaluation of departmental structure, reporting relationships and staff.
• Responsible for evaluation of workload, promoting optimal productivity.
• Oversight of cross-training and education of employees.
• Support ongoing education and leadership development of management staff.
• Responsible for identifying customer service needs, improving, and meeting customer expectations.
• Conduct regular Department meetings and in-services.
• Oversee resolution of staffing issues, counseling of personnel, and following grievance procedures when warranted.

Financial Responsibility

• Maintains fiscal responsibility accountability for Medical Staff Services and assists with an annual budget.
• Develop/coordinate preparation of both Operating and Capital Budgets.
• Oversight and management of budget evaluations, submission of variance reports and action planning to address areas for immediate attention.
• Oversee and/or implement new or revised programs.

Required for All Jobs

• Performs other duties as assigned.
• Complies with all Wellstar Health System policies, standards of work, and code of conduct.