Manager, Network Medical Staff Admin & Managed Care

Job Summary: The Manager of Network Medical Staff Administration and Managed Care is responsible for assisting in the administration and supervision of systematic operations, pertaining to practitioner credentialing, privileging and managed care across the WMCHealth Network. This role collaborates with departmental staff, medical staff, and key stakeholders to ensure that a high-quality credentialing and privileging program is maintained, while upholding the mission and values of the WMCHealth Network and its related entities. This encompasses ongoing extensive knowledge of the Joint Commission (TJC), Det Norske Veritas (DNV), Center for Medicare and Medicaid (CMS), and New York State (NYS) regulatory requirements, in conjunction with the respective bylaws. This position directly reports to the VP of Network Medical Staff Administration

Responsibilities:

• Manages medical staff administration activities to ensure that the administrative responsibilities of Medical Staff Administration and Managed Care are met.
• Provides administrative oversight of the medical staff credentialing and privilege activities in accordance with the medical staff policies, bylaws, and rules and regulations to ensure that only qualified practitioners provide care.
• Collaborates with all internal and external Managed Care stakeholders’ network to ensure that all NCQA requirements are successfully met.
• Provides supervision of network Managed Care responsibilities pertaining to medical staff provider credentialing activities, audits and surveys as required.
• Monitors and supports network database activities by generating reports, reviewing daily audits, and monitoring staff performance to ensure that all practitioner credentialing, privileging, and managed care requirements are met.
• Supports all network credentialing activities as directed by the VP of Network Medical Staff Administration.
• Assists in planning, managing, and implementing Medical Staff and Managed Care credentialing activities.
• Develops and cultivates working relationships with internal and external key stakeholders to ensure appropriate awareness of various issues.
• Supports and manages organizational practices to ensure compliance with network accreditation standards and regulatory requirements.
• Communicates critical information regarding organizational programs and policies as assigned.
• Collaborates as requested with physician leadership to maintain facility-specific, criteria based clinical privileging system in accordance with regulatory requirements, accreditation standards, and organizational policies.
• Assists in the on-boarding process of practitioners and staff to meet educational and training requirements.
• Knowledge of risk management concepts, such as identifying, monitoring, and managing potential risks in order to minimize the negative impact on organization.
• As directed, manages the department’s participation in surveys and audits of regulatory and accreditation agencies or organizations as requested.
• Identifies and supports performance improvement concepts, such as setting goals, implementing systematic changes, measuring outcomes, and optimizing resources to meet the needs of each facility.
• Represents Medical Staff Administration at various meetings, as directed.
• Manages qualified staff to accomplish daily operational requirements.
• Offers technical and administrative support to the medical staff and department as needed.
• Assists the VP of Network Medical Staff Administration as requested.
• Performs other duties as assigned.

Qualifications/Requirements:

Experience:  5 years of experience in the medical staff credentialing field

Education:  Bachelor’s degree in a healthcare related field required..

Licenses / Certifications: Certified Provider Credentialing Specialist (CPCS) preferred, Certified Professional in Medical Services Management (CPMSM) preferred

Other:

Values and models integrity and honesty by acting in a just, fair, and ethical manner and encouraging ethical behavior, among others. Inspire trust and confidence among stakeholders through reliability, authenticity, and accountability.

Expresses thoughts clearly, concisely, and effectively both verbally and in writing. Ensures a free flow of information and communication upward, downward and across the organization by actively listening and encouraging the open expression of ideas and opinions.

Displays a credible presence and positive image. Earns other people’s confidence through consistent action, values, and communication. Uses appropriate protocol for professional and social situations.

Establishes productive, cooperative relationships with subordinates, peers, management, and stakeholders both internal and external to the organization. Understands and responds to others’ needs and priorities. Gives and seeks feedback that will increase the productivity of relationships and networks with peers and associates to build a support base.

Takes all critical information into account, considering interrelationships among issues and implications for other stakeholders. Applies knowledge, expertise, and sound judgment and consults other references and resources as necessary to generate and evaluate solutions and recommendations. Understands and appropriately applies principles, procedures, requirements, regulations, and policies.

Collaborates and shares plans, information, and resources. Encourages and facilitates cooperation, trust, and group identity and builds commitment, team spirit, and strong relationships. Works collaboratively and relates effectively to others by practicing, valuing, and embracing diversity of individuals, and fostering respect and equity in the workplace.