Manager, Credentialing - University of Rochester Medical Center : Job Details

Overview

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As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive.

Job Location (Full Address): Remote Work - Albany, New York, United States, 12224

Opening: Regular

Time Type: Full time

Scheduled Weekly Hours: 40

Department: 910397 URMC Medical Staff Services

Work Shift: UR - Day (United States of America)

Range: UR URG 112

Compensation Range: $70,197.00 - $105,295.00

The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.

Responsibilities

• Oversees departmental activities to ensure quality in conducting, maintaining, and communicating the medical and allied health professional staff credentialing, privileging, and primary source verification process. Serves as a leading resource of the department, and collaborates with others to advance the quality of practitioners and patient safety of the facility. Supervises ongoing compliance monitoring. Recruits, hires, supervises and manages the performance of department staff members.
• Ensures the Medical Staff Services department is in compliance with regulatory standards, including but not limited to The Joint Commission (TJC), CMS, NCQA, State Department of Health, OSHA, and other regulatory agencies that govern healthcare. Supervises ongoing compliance monitoring, including monitoring health review requirements, professional licenses, DEA, sanctions, NPDB, complaints, and adverse information regarding quality of care. In collaboration with the Payer Enrollment Manager, coordinates delegated credentialing and commercial payer enrollment contracts with contracted payers. Represents Medical Staff Services and the Credentials Verification Organization (CVO) for regulatory audits/surveys. Collaborates with UR Contracting and Commercial Payers regarding contracts related to delegated credentialing. Works with leadership to develop and maintain credentialing policies to ensure regulatory compliance. Provides education to staff on medical staff bylaws and credentialing policies and procedures. Attends educational seminars and conferences to stay current with best practices and evolving standards.
• Oversees the Credentials Privilege Review, Committee and Board Approval Process. Supervises department review and recommendation processes for membership and privileges at multiple affiliate hospitals. Supervises privileging approval for Strong Memorial Hospital and Highland Hospital. Manages FPPE/OPPE processes for those hospitals. Oversees the Credentials Privilege and Review Committee process for Medical Staff and Allied Health practitioner appointments and privileges at multiple affiliate hospitals. Supervises weekly expedited credentialing and review committee, Medical Executive, and Board approval processes; supervises emergency privilege processes as needed for all affiliates.
• Develops and maintains electronic privileging data and criteria within the credentialing software database. Maintains data security appropriate to the client/hospital affiliate and staff. Coordinates quality initiatives, tracks file processing accuracy, and implements improvements. Maintains account data for reporting on active and historical medical and allied health staff. Collaborates with Lean Performance Improvement Office where applicable.
• Recruits, hires, manages performance, and supervises staff to achieve departmental objectives. Develops tools and policies for knowledge management, record keeping, and internal/external communication. Supports director in overall department management, team building, and retention strategies. Regularly reviews performance measures and provides performance improvement plans as needed.
• Coordinates and oversees Proxy Credentialing for URMC's contracted telehealth services. Responsible for invoicing and accounts receivable for credentialing services provided to affiliates and clients. Assists the Director with fiscal management and administrative activities. Responds to inquiries from external organizations and represents MSS for initiatives and committees as needed. Serves as primary back up to MSS Department Director and other MSS managers.
• Other duties as assigned.

Minimum Education & Experience

• Bachelor's degree in business or healthcare related field and 5 years of experience in Medical Staff credentialing and/or payer enrollment functions required
• Or equivalent combination of education and experience
• Previous experience with Joint Commission, CMS, and NCQA regulations related to medical staff services and commercial payers credentialing required
• Previous management experience preferred

Knowledge, Skills And Abilities

• Excellent interpersonal and communication skills with the ability to develop and maintain relationships with a variety of key stakeholders across the organization (preferred)
• Demonstrated success in leading through change while utilizing effective change management tools (preferred)

Licenses and Certifications

• CPMSM - Certified Professional Medical Services Management upon hire preferred
• Certified Provider Credentialing Specialist (CPCS) upon hire preferred

The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture to advance the University's Mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion, creed, sex, sexual orientation, citizenship status, or any other characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.

Seniority level

• Mid-Senior level

Employment type

• Full-time

Job function

• Human Resources

Industries

• Higher Education

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