Mgr, Credentialing, MSS

Orlando Health, Inc.; Orlando (FL); On-site; USD 90,000 - 120,000; Full time

Job summary

Orlando Health is seeking a Credentialing Manager to oversee initial credentialing and reappointments, ensuring integrity and regulatory compliance across all facilities. You will manage a team, coordinate with Medical Staff leadership, and uphold standards in line with bylaws and policies.

Responsibilities include directing credentialing workflows, ensuring data accuracy, and improving processes. Bachelor's degree or equivalent experience is required, CPCS/CPMSM certification within 2 years,

Qualifications

• Bachelor's degree in Healthcare Administration and Management or 8 years of related Medical Staff Services credentialing experience.
• CPCS or CPMSM certification within 2 years of hire.
• Five (5) years of experience interacting with hospital administration, Medical Staff Leadership and credentialing activities.

Responsibilities

• Oversee all credentialing and privileging processes for physicians and allied health practitioners.
• Lead and develop the Medical Staff Services credentialing team, including hiring, coaching and performance management.
• Ensure compliance with regulatory, accreditation and Orlando Health bylaws, policies and procedures.

Education

Bachelor's degree in Healthcare Administration and Management, or related field

Job description

Position Summary

Status: Full-Time

Location: NEW Lakeland Highlands Hospital, Lakeland, FL Fully onsite

At Orlando Health, we are ordinary people with extraordinary individuality, working together to bring help, healing and hope to those we serve. By daily embodying our over 100-year legacy, we reinforce our reputation as a trusted and respected healthcare organization that delivers professional and compassionate care to our patients, families and communities. Through our award-winning hospitals and ERs, specialty institutes, urgent care centers, primary care practices and outpatient facilities, our 27,000+ team members serve communities that span Florida’s east to west coasts and beyond.

Orlando Health - Benefits & Perks

All Inclusive Benefits (start day one)

• Student loan repayment, tuition reimbursement, FREE college education programs, retirement savings, paid paternity leave, fertility benefits, back up elder and childcare, pet insurance, PTO/Holidays, and more for full time and part time employees.

Forbes Recognizes Orlando Health as a Best-In-State Employer

• Forbes has named Orlando Health as one of America's Best-In-State Employers for 2024. Orlando Health is the top healthcare organization in the Metro Orlando area to make the prestigious list. "We are proud to be named once again as a best place to work," said Karen Frenier, VP (HR). "This achievement reflects our positive culture and efforts to ensure that all team members feel respected, supported and valued.

Position Summary

The Medical Staff Services Credentialing Manager is responsible for overseeing the development, implementation, and integrity of the initial credentialing and reappointment activities in accordance with regulatory and accreditation standards, as well as the Orlando Health Bylaws, Policies and Procedures, Rules & Regulations. This position also manages team member functions and accountability.

Responsibilities

Essential Functions

• The Manager, Credentialing, Medical Staff Services effectively implements administrative and operational activities of the Medical Staff and its Leadership. Operationalizes results of discussions, recommendations, and actions of the Medical Executive Committee and the Credentials Committee.
• Exhibits extensive attention to detail and requires attention to detail from all team members.
• Exhibits and promotes within the Medical Staff Services team excellent customer service to Medical Staff leaders, medical staff members, medical staff applicants, hospital administration, and internal and external customers.
• Implements all credentialing and privileging processes and procedures for all physicians and allied health practitioners, including establishing qualifying criteria for initial appointment.
• Formulation and revision of all application materials; professional profiling for reappointment.
• Assists direct leader, in concert with legal counsel and Medical Staff Leadership, to facilitate amendments to Medical Staff governance documents to ensure compliance with regulatory, statutory, legal, and accreditation bodies and their required standards, as well as with Medical Staff Bylaws, Policies/Procedures, and Rules & Regulations for all facilities.
• Assists direct leader with physician investigations (both behavioral and clinical competency), notifies practitioner of adverse action, and administers the Fair Hearing & Appeal Process, as required.
• Primary responsibility for orientation and training, system upgrades/updates, and systems reporting to all downstream systems from the credentialing database workflow system.
• Creates implements and reconciles clinical privileges to numerous internal clinical service areas.
• Responsible for planning, organizing, leading and directing Medical Staff Services credentialing team activities; appropriately addresses staffing needs, hires, trains, evaluates, coaches and manages team, including establishing goals and objectives for the development of departmental human resources.
• Assists direct leader with preparing, tracking, and manages fiscal budget and restricted account.
• The Credentialing Manager will ensure that the credentialing database workflow system use is maximized.
• The Credentialing Manager of the Medical Staff Office is a supportive, effective, efficient team member dedicated to meeting the needs of the Medical Staff and its Leadership.
• Educates team members on organizational objectives and ensures their understanding of the team’s part in meeting those objectives.
• Manages various personnel functions including hiring, work assignments, coaching plans, and disciplinary actions for the medical staff office personnel.
• Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state and local standards.
• Maintains compliance with all Orlando Health policies and procedures.

Other Related Functions

• Operates with independent judgment on behalf of the Chief of Staff and the Credentials Committee Chairman
• Coordinates and works effectively with the Health Information Management, Regulatory, Infection Control, Quality Teams, and all other departments that impact the Medical Staff at the organization
• Participates in regional and National Associations for the advancement of the medical staff organization, credentialing and privileging, and medical staff services professionals. Represents Orlando Health through community interaction and related organizations.

• Continually updates skills, knowledge and certification. Conducts literature reviews and research on changes in medical staff privileging and makes proposals to enhance credentialing and privileging activities within the organization.
• Actively participates in professional organizations, including FAMSS, etc. for networking purposes

Qualifications

Education/Training

Bachelor's degree in Healthcare Administration and Management, or a related field OR 8 years of experience in Medical Staff Services credentialing and operations may be substituted for bachelor’s degree.

Licensure/Certification

CPCS or CPMSM certification required within 2 years of hire.

Experience

Five (5) years of experience interacting with hospital administration, Medical Staff Leadership, Medical Staff physicians, credentialing activities and/or two years directly related medical staff support experience. Significant experience in use of workflow systems and development of reporting. Experience with change management and streamlining of workflow processes.