Director, Credentials Verification Organization

Wellstar Health System; Marietta (GA); On-site; USD 120,000 - 150,000; Full time

Job summary

Wellstar Health System is seeking a Director to lead the Credentials Verifications Organization (CVO) with overarching responsibility for credentialing and privileging across the system. The role ensures a high-quality, timely application process for Medical Staff and Allied Health Professionals in alignment with bylaws and regulatory standards.

The position focuses on staff leadership, regulatory compliance, and cross-department collaboration to meet CMS, Joint Commission, and NCQA requirements

Qualifications

• Knowledge of medical staff credentialing/privileging processes.
• Strong understanding of state/federal regulatory requirements and accreditation standards.
• Ability to lead, manage, and effect change in a complex health-system setting.
• Ability to multitask, prioritize, delegate, and meet deadlines with minimal supervision.

Responsibilities

• Oversee credentialing/privileging for Medical Staff and Allied Health Professionals across Wellstar entities.
• Ensure timely and compliant application processing per bylaws, Joint Commission, NCQA, CMS, and regulations.
• Maintain current electronic credential files and essential documents.
• Coordinate with Legal and Risk Management on medico-legal issues.

Skills

Leadership

Communication

Regulatory knowledge

Problem solving

Education

Bachelor’s in Business Administration/Health Administration

Tools

Medical staff database technology

Job description

Work Shift

Day (United States of America)

Job Summary

The Director, Credentials Verifications Organization (CVO) provides strategic leadership to the system CVO and has overall responsibility for leading and maintaining a high quality and comprehensive credentialing and privileging program supporting Wellstar's mission, vision and values. Through effective staffing and management and collaboration with applicants and other departments, this position oversees the successful implementation of the system application process to credential and privilege all practitioners in accordance with the bylaws, rules and regulations and policies of Wellstar Health System. In addition, manages the expectations and outcomes around processing times as well as communication with applicants, vendors and other Wellstar departments This position has responsibility for monitoring all applicable regulatory laws and statutes (State and Federal) and accreditation standards. This includes, but not limited to, system compliance with State, CMS, and Joint Commission requirements

Core Responsibilities And Essential Functions

Credentials Functions: Provide high-quality, single-application process for Medical Staff and Allied Health Professionals in a timely, cost-effective manner.

• a. Oversight of credentialing/privileging for Medical Staff, Advanced Practice Professionals and Allied Health Professionals for Wellstar Health System hospitals, Wellstar Medical Group, PHO, Wellstar Clinical Partners and delegated credentialing for managed care organizations.
• b. Assure application process initiated and completed per Medical Staff Bylaws, the Joint Commission and NCQA standards, CMS and state/federal regulations.
• c. Analytical responsibility for credentialing information obtained during application process.
• d. Responsible for maintenance of current, electronic credential file including maintaining current required documents (professional license, DEA, liability insurance, board certification, etc.).
• e. Oversight of communication with all applicants regarding membership and privileging.
• f. Assures appropriate interface with Wellstar Legal and Risk Management regarding credentialing

Regulatory Compliance/Continuous Survey Readiness

Maintains current working knowledge of all regulations, statutes, laws and accreditation standards that regulate the organized medical staff and the credentialing process. Provide guidance and serve as expert resource to the Medical Staff Leadership and organization in these areas. Identify the need for amendments to documents such as Medical Staff Bylaws, Policies or Rules and Regulations when required to maintain compliance.

• a. Responsible for compliance with all appropriate regulatory body standards, state requirements and procedures.
• b. Demonstrates accurate knowledge of Medical Staff Bylaws, Rules and Regulations, and policies and procedures.
• c. Coordinates and participates in development and revision of documents to ensure compliance.
• d. Acts as liaison between Medical Staff and Health System attorneys on medico-legal issues as needed.

Communication

Serve as liaison between Medical Staff, Administration, Senior Leadership and other Departments. Assures customer service by the Credentials Verification Organization. Improve and promote communication and teamwork among the various Medical Staff Organizations as well as within the Department and between Medical Staff Services and Medical Staff Leadership, Administration, Senior Leadership and other related Departments. Foster team approach between departments in the communication of information related to credentialing and other pertinent support functions.

• a. Maintains excellent working relationship with Medical Staff Offices and Medical Staff/Allied Health Staff Members.
• b. Interacts appropriately with internal and external departments (Wellstar Medical Group, affiliated groups, IT, Administration, Board of Trustees, Wellstar Clinic Partners, etc.).
• c. Responsible for reports to the Medical Staff, Administration, Senior Leadership and other departments as required

Management/Staff Development

Creates and maintains a positive work environment. Develop, support, and encourage educational opportunities (formal and informal) for Medical Staff Services professionals to promote quality leadership and support services.

• a. Collaborate with Senior Leadership to define the goals and objectives of the Medical Staff Services Department ensuring alignment with System strategic goals.
• b. Provide staff with clear expectations, goals, directions and identify areas of opportunity for improvement.
• c. Oversight of personnel management from recruitment to employee development.
• d. Interview, hire and orient staff for direct report positions.
• e. Oversight of Medical Staff Services job performance standards.
• f. Oversee/assist in performance evaluations. Complete performance evaluations for direct reports.
• g. Responsible for evaluation of departmental structure, reporting relationships and staff.
• h. Responsible for evaluation of workload, promoting optimal productivity.
• i. Oversight of cross-training and education of employees.
• j. Support ongoing education and leadership development of management staff.
• k. Responsible for identifying customer service needs, improving, and meeting customer expectations.
• l. Conduct regular Department meetings and in-services.
• m. Oversee resolution of staffing issues, counseling of personnel, and following grievance procedures when warranted.

Financial Responsibility

Maintains fiscal responsibility accountability for Medical Staff Services and assists with an annual budget.

• a. Develop/coordinate preparation of both Operating and Capital Budgets.
• b. Oversight and management of budget evaluations, submission of variance reports and action planning to address areas for immediate attention.
• c. Oversee and/or implement new or revised programs.

Required For All Jobs

• Performs other duties as assigned
• Complies with all Wellstar Health System policies, standards of work, and code of conduct.

Job Qualifications

Required Minimum Education:

• Bachelors Business Administration/Management or Health Administration Required
• Additional relevant work experience and/or other specialized training can be used to lieu of minimum education requirement.

Required Minimum Experience

• Minimum 8 Years comprehensive experience as a medical staff services professional within a hospital setting or CVO setting with increased levels of responsibility, to include supervisory experience Required.
• Experience using medical staff database technology required and must support optimal use of the database.

Required Minimum License(s) And Certification(s)

CPCS (Cert Provider Credential Spec) - Preferred Upon Hire

CPMSM (Cert Prof in Med Service Mngmt) - Preferred Upon Hire

Required Minimum Skills

Must have working knowledge of medical staff credentialing/privileging processes and comprehensive knowledge base of state/federal regulatory requirements and accreditation standards related to the organized medical staf

Must have documented experience with multiple medical staff departments and committees and supervisory responsibility for five or more support staff.

Must have a working knowledge of all areas of medical staff governance, including practitioner credentialing and privileging processes and the applicable Joint Commission and NCQA standards that address medical staff organizational requirements.

Must have knowledge of current federal and state laws and regulations relevant to medical staff functions and have the ability to draft needed revisions to documents required for compliance.

Must demonstrate personal attributes and behavior that contributes to a climate of excellence. Demonstrates ability to lead, manage, and/or effect change.

Must demonstrate the ability to use discretion and independent judgment when problem solving or assisting leadership in decision‑making processes and must maintain confidentiality in all aspects of medical staff and peer review information.

Must be able to effectively multitask, prioritize, delegate, organize and meet deadlines established and agreed upon for optimal results as defined.

Must be able to adapt to a flexible work schedule with frequent interruptions, possess strong communication and people skills, must have the ability to motivate and lead, and perform duties and responsibilities promptly and consistently with little direct supervision. Excellent problem‑solving skills with the ability to judge the appropriate action in response to changes, circumstances or problems is required as well as the ability to effectively communicate through written material and oral presentations to groups or individuals, using computer enhancements as needed or desired.

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