Medical staff manager
- Serves as technical expert in medical staff credentialing and privileging, delegated credentialing agreements and other medical staff processes and their associated standards, rules, and regulations.
- Maintains technical knowledge and expertise of NCQA and Joint Commission medical staff and credentialing standards, CMS and Federal Laws. Audits and reviews practices functioning as a resource within the System on all credentialing processes. Liaison and primary spokesperson for Medical Staff Affairs and represents the organization as required. Provides annual education to medical staff leaders, administration and Board of Directors on credentialing processes, including reports to Board of Directors as requested. Provides orientation of new medical staff leaders, administration and board members as necessary related to Medical Staff Affairs.
- responsibleTJC for processes supporting the implementation of standards for medical staff credentialing and privileging.
- Develops, coordinates, and maintains processes, policies and procedures to facilitate credentialing services and contracted entities, including initial and reappointment processes. Interprets language and standards and implements systems to comply with CMS, Joint Commission, and NCQA regulations and federal and state laws in all medical staff processes and contracts. Primary resource for compliance, health plan audits, and credentials criteria. Negotiates and recommends amendments on all credentialing contracts, with final approval from legal team.
- Evaluate and report to departmental/organizational senior management on status and changes in Medical Staff issues.
- Attends meetings as a resource for medical staff bylaws, policies, and rules and regulations as necessary.
Supports and attends Credentials committee, acting as resource for all credentialing actions being taken, and communicates actions forward to the Medical Board and Board of Directors.
Attends Medical
Board meetings to function as resource for medical staff bylaws, policies, rules and regulations, and medical staff structure. Supports and attends the Investigation Committee and serves as alternate for the Medical Staff Behavioral Committee and the Provider Health Committee.
- Educates medical staff leaders regarding matters involving credentialing actions, including facilitating medical staff hearings for all credentialing matters. Assists UW Health attorneys with all preparations relating to medical staff hearings, advising on reportable credentialing actions, compliance with medical staff bylaws, and current credentialing legal cases. Remains knowledgeable of negligent credentialing cases, NPDB changes, credentialing and medical staff statutes for both state and federal law. Assesses legal precedents and effect on credentialing and/or medical staff processes and communicates to medical staff leaders appropriate changes.
