CREDENTIALING MANAGER (100% REMOTE)

Collaboratively develops implementation plans that convert strategy to operating tactics.
This position will be required to balance the needs of UW Medicine and University of Washington Physician Network at the same time ensuring compliance with TJC, DOH and NCQA Accreditation Standards and UW Health Systems by-laws.

The Manager is responsible for credentialing/privileging of medical staff and allied health professionals and any related administrative, budgetary, and regulatory duties that impact UW Medicine Hospitals. The Office of Medical Staff Appointments process on average 500 new applicants and 1500 reappointment applications annually. Duties include but are not limited to the following: participation in credentialing/privileging activities, professional liability reviews, participation in meetings, supervision of employees, budget preparation/financial analyses, written/verbal correspondence with external agencies or individuals, continuous quality improvement, and management of the daily operations of Office of Medical Staff Appointments department.

DUTIES AND RESPONSIBILITIES

Medical Services Administration

Maintenance of a complete and accurate record of UW Health Systems facilities review and approval process by collect and compile committee tables, discussions, and actions.  Administer management responsibilities as they pertain to medical staff services in accordance with internal and external policies, rules, and regulations.  Assisting with budgetary and resource planning needs. Provide a comprehensive instruction and guidance to the UW Health System credentialing and privileging process for practitioners/providers and department medical services staff.  Participate in organizational initiatives by providing expertise on medical services topics and advising on accreditation and regulatory issues in order to maintain compliance.

Management of Credentialing Processes

Apply the credentialing process uniformly to all practitioners/providers in accordance with organizational policies in order to address all stakeholder interests. Compile data required for the uniform assessment of practitioners/providers as determined by organizational policy in order to support the evaluation of current competency. Oversee the status of all practitioner/provider expirables (e.g., licenses, certifications, insurances) by querying primary sources in order to validate currency and to ensure ongoing eligibility with the UW Medicine. Verify the absence of sanctions and complaints for all practitioners/providers by researching appropriate sources in order to ensure ongoing eligibility with the organization. Report adverse actions taken against a practitioner/provider by notifying the appropriate authorized agency in accordance with applicable law in order to protect the public.

Privileging

Monitor requested privileges to assure they are uniformly applied to each appointment and reappointment using established criteria based on education, training, and experience in order to ensure current competency.  Ensure the applicability and appropriateness of clinical privileges for each specialty through collaboration with Clinical Department Chairs and Medical Director for each facility such as UW Medicine, Harborview Medical Center, and Seattle Cancer Care Alliances.

Process Improvement and Information Management

Manage policies governing the distribution of information in accordance with accreditation, regulatory, and organizational requirements.  Participate in the assessment, procurement, implementation, and maintenance of practitioner/provider information systems by communicating the needs of medical service functions in order to manage data with efficiency and integrity. Manage information as it pertains to medical staff services in accordance with confidentiality requirements, using programs (e.g., MSOW, SOMAS, Microsoft Office, EMAIL, and INTERNET)

Manage or lead departmental process improvement projects. Measure and report all cost savings and increase efficiency in departmental processes. Lead and participate in work groups to evaluate and implement continuous improvement and application of lean methodology for rapid improvement. Manage and increase teamwork across all improvement efforts, training and building team skills where appropriate for successful implementation of Lean. Maintenance of a complete and accurate record of UW Medicine facilities review and process by collecting and compiling committee tables, discussions and actions. Work with leadership to create and distribute regular communications or e-blasts to clinical departments.

Accreditation and Regulatory Compliance

Serve as the organization’s expert regarding relevant accreditation and regulatory requirements by applying current knowledge of published standards in order to ensure ongoing compliance. Ensure compliance of governance documents (e.g., bylaws, policies, procedures) consistent with current accreditation and regulatory standards in order to ensure quality patient care. Implement a periodic review process for bylaws, policies, and procedures consistent with organizational policy in order to ensure ongoing compliance with accreditation and regulatory requirements such as (e.g., TJC, NCQA, CMS, AAAHC, and URAC).

Risk Management

Maintain and track practitioner/provider performance data, profiles, and Risk Management Compliments/Complaints. Assure inclusion of all practitioner/provider performance data, profiles, and Risk Management Compliments/complaints a as part of reappointment process in order to ensure uniformity, fairness, and quality of patient care.

HR Lead Responsibilities

Collaborate with the Dean of Medicine Human Resources for OMSA, including assisting in development of new positions, interviewing job candidates, selecting, and training new employees, ensuring compliance with established department performance expectations, and evaluating classified staff performances.

MINIMUM REQUIREMENTS