Employment Type:

Full time

Shift:

Day Shift

Description:

Directs Trinity Health's system-wide Central Verification/Center for Practitioner Information ensuring an efficient and effective operation in compliance with various regulatory agencies (CMS, TJC, NCQA, HFAP, DNV, etc.). Leads process improvement and implementation of evidence based, and best practice standards for system-wide credentialing verification and re-credentialing/privileging for RHMS, ACOs, CINs, PNO and delegated Health Plans as well as Provider Enrollment. Directs, organizes, monitors and analyzes operations and integration of standardization to meet system, legal, regulatory and accreditation requirements for both RHMs and Population Health entities.  Develops strategic initiatives and implementation strategies for effective and efficient credentialing, privileging, provider data management, medical staff bylaws, policies, procedures, and verification functions supporting credentialing and privileging within Trinity Health and its Regional Health Ministries (RHMs) including NCQA certified delegated credentialing and Provider Enrollment.

ESSENTIAL FUNCTIONS

Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.

Directs the Trinity Central Verification Office/Center for Practitioner Information including initial and re-application credentialing responsibilities for Trinity Health's RHMs, CINs, ACOs, PNOs and other healthcare entities as appropriate such as delegated Health Plans, and managed care organizations. Develops and manages the department budget, controls staffing levels for appropriate operation, identifies reduction of duplication work effort, and ensures operation within budget.  Creates and reviews weekly, monthly, annually and special reports to ensure conformance with departmental goals and regulatory requirements.

Establishes staffing plan and manages human resources necessary to ensure an efficient credentialing operation (including hiring, orientation, training, performance management, and establishment of department goals). Provides appropriate in-service of regulatory and credentialing standards, evaluates procedures, and facilitates continuing educational opportunities for staff. Plans office staff activities and work projects; supervises personnel to carry out and complete specific projects and duties.

Directs the activities required to maintain an NCQA certified and a quality provider network through appropriate activities as specified in the policy and procedure manual and delegated credentialing agreements regarding initial credentialing and re-credentialing.

Develops and implements process changes to improve the credentialing function. Contributes to the safety and quality care of patients through the accurate and timely credentialing and re-credentialing of over 25,000 medical staff members and 16,000 members of our accountable care organizations.

Directs the financial viability of Trinity Health and their practitioners through facilitating delegation with commercial payers.

Oversees the maintenance of the credentialing database to ensure a reliable source of practitioner physician information and privileges.

Implements and oversees NCQA, TJC and Trinity Health certified policies and procedures to ensure deliverable services to various key users (RHMs, CINs, ACOs, and MCOs with delegated credentialing agreements).

Develops and maintains positive working relationships with RHM, Health Plan and System Office customers.

Develops and implements processes or reviews and revises current credentialing policies and procedures to ensure compliance with Trinity Health and MCO quality management requirements (TJC, NCQA, NPDB, etc.). Establishes implementation strategies for centralized credentialing and re-credentialing verification processes.

Leads the development and implementation of standardization and consistencies in practitioner data and verification elements for each RHM, ACO, etc.

Facilitates maintenance of present facilities, office equipment, contracted services, etc. Assumes responsibility for performance of job duties in the safest possible manner, to ensure personal safety and that of coworkers who are on-site and in remote locations, and to report all preventable hazards and unsafe practices immediately to management.

Establishes and maintains an appropriate customer satisfaction standard; encourages constructive and cooperative conflict resolution; promotes positive customer relationships. Promotes and leads collaborative relationships with RHM, CIN, ACO, MPPS administrative staffs, MCO support staff, and internal department staff for a smooth and effective credentialing and