Supervisor, Medical Staff Office

Kaiser Permanente; California; On-site; USD 79,000 - 102,000; Full time

Benefits offered by this job

Travel opportunities

Job summary

Kaiser Permanente in Los Angeles (West LA Medical Center) seeks a Team Leader for Credentialing and Privileging. You will supervise a team to review primary source verifications, manage enrollment, and drive improvements across credentialing processes.

Requires leadership experience, knowledge of credentialing standards, and ability to coordinate with multiple stakeholders to ensure compliance and timely decisions.

Qualifications

• Experience in credentialing governance and regulatory standards.
• Strong leadership and team supervisory skills.
• Proficiency with databases and data analysis.

Responsibilities

• Supervise team to review primary source verifications and applications.
• Identify gaps in vendor relationships and drive improvements.
• Manage provider enrollment and credentialing workflows.
• Lead audits and collaborates with stakeholders to ensure compliance.

Job description

Job Summary:Supervises team to review and request primary source information and verifications. Proactively identifies, suggests improvements to, and provides resolution for complex gaps in vendor relationships. Serves as an escalation point of contact for external queries regarding practitioner status. Evaluates applications and supporting highly complex documents. Guides team to conduct improvements to credentialing and privileging processes. Guides and supervises team to evaluate complex practitioner sanctions. Participates in surveys and audits of credentialing entities. Facilitates and implements strategic initiatives cost-effective due process. Identifies and provides leadership to resolve adverse actions/issues. Leads and evaluates audits of data between different departments. Conducts and supervises the facilitation and orientation and training to newly appointed physician leaders. Develops highly complex informational documents. Maintains working relationships with key stakeholders. Maintains awareness of current policy and climate interactions. Guides team to facilitate meetings with leadership to develop on-boarding processes. Supervises team to process complex provider enrollment information. Ensures team completes communications to relevant information to appropriate parties. Supervises team to enact control of data systems and applications. Supervises team to ensure credentialing data analyses. Reviews multiple types of structures database structures and data. Communicates status, leads development of corrective action plans, and collaborates with relevant teams to conduct audits and site visits.Essential Responsibilities:Recommends developmental opportunities for others; builds collaborative, cross-functional relationships. Solicits and acts on performance feedback; provides team members with feedback; and mentors and coaches to drive performance improvement. Pursues professional growth; provides training and development to talent for growth opportunities; supports execution of performance management guidelines and expectations. Implements, adapts, and stays up to date with organizational change, challenges, feedback, best practices and processes. Fosters open dialogue, supports, mentors, engages, and motivates team members on collaboration. Delegates tasks and decisions as appropriate; provides appropriate support, guidance and scope.Supervises and coordinates daily activities of designated work team or unit by monitoring the execution and completion of tactical action items and work assignments; ensures all policies and procedures are followed. Aligns team efforts and standards, and measures progress in achieving results; determines and carries out processes and methodologies; resolves escalated issues as appropriate. Develops work plans to meet business priorities and deadlines; coordinates, obtains and distributes resources. Removes obstacles that impact performance; identifies and recommends improvement opportunities; influences teams to execute in alignment with operational objectives.Leads training and regulatory awareness by: guiding team to and independently facilitating orientation and training to newly appointed physician leaders for effective oversight and management of their departments credentialing, proctoring, privileging and reappointment processes; supervising team to and independently developing complex informational/educational documents (newsletters, memos) to communicate critical information regarding organizational programs and policies; supervising the development and cultivation of working relationships with key stakeholders, both internal and external, to ensure appropriate awareness of key issues and decision-making; guiding team to facilitate meeting with leadership to develop on-boarding processes (orientation, training activities) to assist practitioners/providers and to meet education requirements; updating applicable governing documents (bylaws, rules and regulations/policies and procedures) that support and direct organizational practices and ensure compliance; and maintaining awareness of current internal policies and external regulations, and legislation.Ensures quality assurance, improvement, and resolution by: guiding and supervising team to obtain and evaluate practitioner sanctions, complaints, and adverse data to ensure compliance; supervising and evaluating ongoing assessments of governing documents (e.g., bylaws/rules and regulations/policies and procedures) to ensure continuous compliance; maintaining collaborative efforts and may be participating in surveys and audits of credentialing entities (e.g., CMOs, delegates and health plans for NCQA); guiding team of techniques and strategies to facilitate efficient and cost-effective due process that complies with internal fair hearing and appeals policies and external legal and regulatory requirements; evaluating team identification, resolving, escalating as needed, and responding to adverse actions/issues (e.g., sanctions and complaints) taken against a practitioner/provider in accordance with applicable law and contractual requirements to the necessary parties; and guiding team to audit and reconcile data between different departments for consistency, and monitoring of credentialing and contracting.Manages the provider enrollment process by: supervising team, reviewing for accuracy, and may be conducting moderately complex detailed and thorough review of the information used to submit the enrollment applications; supervising team to prepare and submit timely data and applications to the contracted and government payors in a manner commensurate with their expectations, policies and accreditation standards; and ensuring team completes communication of enrollment status to all stakeholders in a clear and timely manner.Leads primary source verification and management by: supervising team to engage in requesting, obtaining, and reviewing information from primary source verifications, and ensuring accuracy in evaluation of applications and provided sources for alignment; maintaining the primary source vendor/relationships to ensure accessibility to information and begin to resolve issues with vendor information; planning and scheduling the continuous process of, providing resources for, and may conduct the review process of applications, primary source verifications, and sources provided to identify potential discrepancies, recognize adverse information, and meet organizational objectives and timelines; leading team to engage in verifying and documenting expirables using acceptable verification sources to ensure compliance with accreditation and regulatory standards; and serving as escalation point for external queries regarding practitioners status, ensuring responses occur in a timely matter.Engages in delegations by: communicating status of, assisting in development of corrective action plans, and identifying gaps or breach of delegated credentialing agreements in alignment with developed strategy for potential and existing delegates; aiding the facilitation of mutual agreement and amendments as needed, obtaining signatures, and maintaining Delegated Credentialing Agreements; scheduling and conducting pre-assessment, annual site visits, and/or electronic assessments to validate credentialing information; and collaborating with State Standardization and Audit teams (e.g., Washington Credentialing Standardization Group Shared Delegation Audit Team, ICE) on shared delegation audits.Conducts database management by: reviewing multiple types of structures and data within a computerized data base of physician data for use in the credentialling and appointment process in alignment with department guidelines.Applies and ensures control and application of data systems by: supervising and reviewing the team to maintain data structures, system functions, creations of workflows, portal management and coordinating the access and controls of data; leading teams to engage in auditing, assessing, procuring, implementing, effectively utilizing, and maintaining practitioner/provider credentialing and delegated processes and information systems (e.g., files, reports, minutes, databases) as outlined; and reviewing, evaluating, and escalating improvements to processes (e.g., electronic board memos) to ensure compliance.Oversees data management and analyses by: supervising team to ensure efficient file completion, conduct privileging analyses, and verify privileging to the appropriate specialty/facility, based on data; and supervising team to leverage and independently leveraging complex tools and policies to support knowledge management, record-keeping, and internal and external communication.Oversees credentialing and privileging maintenance and management by: guiding teams to implement requirements when completing evaluation of application and supporting documents for completeness and to determine applicants initial eligibility for membership/participation; serving as an escalation point of contact for practitioner during application process, providing timely updates and additional information as requested; planning and scheduling team to prepare and complete complex documents (e.g., Board Reports, Delegation reports) related to practitioner-specific data for presentations to decision-making bodies (e.g., committees); guiding teams to implement and may suggest improvements to credentialing and privileging processes for all practitioners/providers; and may be leading, facilitating, and serving on internal and external committees, and gathering documentation needed for committees to influence decisions on the enforcement and development of policies/procedures for regulations and auditing processes.Knowledge, Skills and Abilities: (Core)Ambiguity/Uncertainty ManagementAttention to DetailBusiness KnowledgeCommunicationConstructive FeedbackCritical ThinkingCross-Group CollaborationDecision MakingDependabilityDiversity, Equity, and Inclusion SupportDrives ResultsFacilitation SkillsHealth Care IndustryInfluencing OthersIntegrityLeadershipLearning AgilityOrganizational SavvyProblem SolvingShort- and Long-term Learning & RecallStrategic ThinkingTeam BuildingTeamworkTopic-Specific CommunicationKnowledge, Skills and Abilities: (Functional)Compliance ManagementConsultingCredentialling IT Application SoftwareDelegationHealth Care ComplianceHealth Care Data AnalyticsHealth Care PolicyHealth Care Quality StandardsManaging Diverse RelationshipsNegotiationProject ManagementQuality Assurance ProcessRisk AssessmentMinimum Qualifications:Minimum two (2) years of experience in a leadership role with or without direct reports.Minimum two (2) years of experience with databases and spreadsheets.Bachelors degree in Business Administration, Health Care Administration, Nursing, Public Health, or related field AND minimum five (5) years of experience in clinical credentialing, accreditation and regulation, licensing, health care, quality, or a directly related field OR minimum eight (8) years of experience in in clinical credentialing, accreditation and regulation, licensing, or a directly related field.Provider Credentialing Specialist Certificate OR Professional Medical Services Management CertificatePreferred Qualifications:One (1) year(s) of experience in delegated credentialing.Two (2) years of experience in medical records administration.Primary Location: California,Los Angeles,West Los Angeles Medical CenterScheduled Weekly Hours: 40Shift: DayWorkdays: Mon, Tue, Wed, Thu, FriWorking Hours Start: 08:00 AMWorking Hours End: 05:00 PMJob Schedule: Full-timeJob Type: StandardWorker Location: OnsiteEmployee Status: RegularEmployee Group/Union Affiliation: NUE-SCAL-01 NUE Non Union EmployeeJob Level: Team Leader/SupervisorDepartment: West LA Medical Center - Hosp Admin-Med Staff Office - 0801Pay Range: $78700 - $101750 / year Kaiser Permanente is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not include the value of our total rewards package. Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills and geographic location along with a review of current employees in similar roles to ensure that pay equity is achieved and maintained across Kaiser Permanente.Travel: Yes, 5 % of the TimeOn-site: Work location is on-site (KP designated office, medical office building or hospital). Worker location must align with Kaiser Permanente's Authorized States policy. Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.For jobs where work will be performed in unincorporated LA County, the employer provides the following statement in accordance with the Los Angeles County Fair Chance Ordinance. Criminal history may have a direct, adverse, and negative relationship on the following job duties, potentially resulting in the withdrawal of the conditional offer of employment:Consistently supports compliance and the Principles of Responsibility (Kaiser Permanente's Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state, and local laws and regulations, accreditation, and licensure requirements (where applicable), and Kaiser Permanente's policies and procedures.Models and reinforces ethical behavior in self and others in accordance with the Principles of Responsibility, adheres to organizational policies and guidelines; supports compliance initiatives; maintains confidences; admits mistakes; conducts business with honesty, shows consistency in words and actions; follows through on commitments.Job duties with at least occasional or possible access to: (1) patients, the general public, or other employees; (2) confidential protected health information and other confidential KP information (including employee, proprietary, financial or trade secret information); (3) KP property and assets, for example, electronic assets, medical instruments, or devices; (4) controlled substances regulated by federal law or potentially subject to diversion.