Network Credentials Specialist

Office of Medical Affairs & Governance

Full Time

77037BR

Job Summary

Works on strategic relationships and joint ventures at all levels of complexity.  Within the strategic framework of UCSF Health expansion, the Network Credentials Specialist initiates and cultivates partnerships with department management, medical staff, and hospital/health plan leadership to ensure compliance and optimal efficiency for appropriate membership, privileges, and health plan enrollments on behalf of UCSF Medical Staff, Advanced Health Professionals, and CVO contracted facilities. 

This person is the first responder to onboarding and revenue channel disruptions as well as auditing functions according to facility Bylaws, Rules, and Regulations; Credentialing Policy and Procedures; and other applicable accreditation/payor standards (e.g. NCQA, TJC, DHS, DMHC, CMS, delegated credentialing agreements, etc.).  Moreover, this person will facilitate and support committees and continuous performance improvement efforts to achieve department and organization goals/deadlines/work plans.  This person will assist in implementing policy and procedures, provide training and orientations to a variety of constituents and support efforts to sustain best practices.

This position works directly with the Network Team, Strategy and the Director of Affiliate Network Credentialing to develop and establish sustainable workflow processes related to credentialing/payor enrollment of community providers who fall under UCSF Health strategic growth.

Department Description

The Office of Medical Affairs and Governance (OMAG) has policy oversight for credentialing and privileging of health care providers, reporting obligations to state/federal licensing boards, and the affiliated community partner groups in the physician network on behalf of the UCSF Health System.  We enroll providers with our contracted health plans and are instrumental in the health system’s billing and revenue operations.  In coordination with the UCSF Office of Legal Affairs, OMAG is also responsible for all medical staff peer review investigations.  

Required Qualifications

• Bachelor's degree in a related area or four (4) years of relevant experience.
• Two (2) or more years of applicable work experience in healthcare administration or a related field.
• Strong knowledge of healthcare industry trends. 
• Advanced knowledge of the medical center or health system's product lines and services.
• Strong quantitative and analytical skills to perform complex market and financial analysis.
• Creative problem-solving skills to assess opportunities and issues and develop solutions.
• Strong interpersonal communication, relationship-building, and political acumen skills.

Preferred Qualifications

• Master’s or advanced degree.
• Strong knowledge of Microsoft Office Suite, and technical skills to learn specialized applications and tools in the field.
• Strong knowledge of physician practice operations, quality measures in value-based care models, managed care relationships and payor contracting.
• Work experience in provider management and committee management.

License/Certification

Certifications (preferred): 

About UCSF

At UCSF Health, our mission of innovative patient care, advanced technology and pioneering research is redefining what’s possible for the patients we serve – a promise we share with the professionals who make up our team.

Consistently ranked among the top 10 hospitals nationwide by U.S. News & World Report – UCSF Health is committed to providing the most rewarding work experience while delivering the best care available anywhere. In an environment that allows for continuous learning and opportunities for professional growth, UCSF Health offers the ideal atmosphere in which to best use your skills and talents.

Pride Values

UCSF is a diverse community made of people with many skills and talents. We seek candidates whose work experience or community service has prepared them to contribute to our commitment to professionalism, respect, integrity, diversity and excellence – also known as our PRIDE values.

In addition to our PRIDE values, UCSF is committed to equity – both in how we deliver care as well as our workforce. We are committed to building a broadly diverse community, nurturing a culture that is welcoming and supportive, and engaging diverse ideas for the provision of culturally competent education, discovery, and patient care. Additional information about UCSF is available at diversity.ucsf.edu

Join us to find a rewarding career contributing to improving healthcare worldwide.

Equal Employment Opportunity

The University of California San Francisco is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Job Code and Payroll Title

004609 PHYSCN NETWORK DEV SPEC 3

Job Category

Government & Public Affairs, Professional (Non-Clinical), Support Services

Bargaining Unit

99 - Policy-Covered (No Bargaining Unit)

Location

Embarcadero Street (SF), Flexible (combination of onsite and remote work), Hybrid, San Francisco, CA