Credentialing & Privileging Manager - Bethesda, United States - MicroHealth, LLC

MicroHealth, LLC

Verified Company

Bethesda, United States

3 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

MicrroHealth 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, monito, 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.
Knowlegdged in the 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:

Bachelor Degree 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 years) knowledge of healthcare highreliability organization principles and transformation
Expert written and verbal communicator
Familiarity with MHS Healthcare Information Systems and Technology
Current 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, ha