Description

Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

JOB SUMMARY

This position is responsible for developing, implementing and maintaining privileging and credentialing processes and procedures which are in compliance with regulatory and accrediting bodies. The Director is responsible for the overall management of the medical staff services functions, including staffing, budgets, database administration, delegated credentialing, and communications Serves as a primary point of liaison between the UNC Health Rex Chief Medical Officer and the Medical Staff, and managed care companies on provider privileging, credentialing, and medical staff policy issues.

DESCRIPTION OF JOB RESPONSIBILITIES

1. Analyzes JCAHO, NCQA, URAC, CMS, NCDOI and other accreditation standards, and develops criteria to ensure compliance. Monitors the currency and accuracy of medical staff bylaws, rules and regulations, and policies/procedures to ensure compliance with accrediting organization requirements. Advises Senior Management and Medical Staff of significant changes in accreditation or regulatory requirements develops/recommends/implements methods for compliance. Participates in onsite surveys by JCAHO, CMS, or other agencies.

2. Advises the Vice President of Managed Care of new or revised NCQA, URAC, CMS, NCDOI or other accreditation/regulatory standards that may impact managed care contracts. Reviews all delegated credentialing agreements tied to managed care contracts advises the Chief Medical Officers of any compliance issues. Revises or develops new policies/procedures in order to comply with current accreditation/regulatory standards. Serves as liaison with the managed care organizations that have delegated credentialing agreements. Participates in the onsite audit of providers' credentials files, as part of the delegated credentialing agreements coordinates the provision of current policies/procedures to the managed care organizations. Develops corrective action plans for identified deficiencies, as needed.

3. Serves as a member of the Central Credentialing Office Council.

4. Directs and administers the credentialing, recredentialing, and privileging process for UNC Health Rex Medical Staff and Allied Health Professionals in accordance with JCAHO, NCQA, URAC, CMS, NCDOI, and other accreditation standards, as well as Federal/State laws and other regulatory agencies. Develops and implements policies and procedures for ongoing monitoring of provider sanctions, complaints, and quality issues between recredentialing cycles takes appropriate action as needed. Interprets and explains accreditation, regulatory, bylaws, and other rules and regulations to the Medical Staff, Senior Management, applicants, and other internal/external customers.

5. Oversees and manages the Medical Staff and Allied Health Professionals data stored in the SMS-PRDOC master file works closely with ISD to assure policy/procedures for data entry are followed. Performs as System Administrator for the credentialing database coordinates and implements security measures to safeguard information in database files against accidental or unauthorized access responsible for granting user access and specifies user read/write rights to data. Monitors critical data for extensive analysis and report generation assures data integrity by frequent data audits coordinates the reporting and distribution of provider data to internal/external customers.

6. Serves as a liaison between Senior Management and the Medical Staff on provider credentialing, privileging and other medical staff policy issues. Functions as primary credentialing and privileging contact for all internal and external customers. Develops and maintains positive working relationships. Conducts credentialing/privileging orientations provides updates, as appropriate, on new policies/procedures.

EDUCATION REQUIREMENTS

Bachelor's degree in an appropriate discipline.

LICENSURE/CERTIFICATION REQUIREMENTS

Certified Professional Medical Services Management (CPMSM) certification by the National Association of Medical Staff Services within 18 months of hire.

PROFESSIONAL EXPERIENCE REQUIREMENTS

Five (5) years of progressively responsible experience in medical staff services administration, credentialing, accreditation, and database management or an equivalent combination of education and experience.

KNOWLEDGE, SKILLS, AND ABILITIES REQUIREMENTS

Knowledge of JCAHO, NCQA, URAC, CMS, NCDOImSer, and other laws/regulations required.

Legal Employer: NCHEALTH

Entity: UNC REX Healthcare

Organization Unit: Rex Medical Staff Services

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Assignment Type: Onsite

Work Schedule: Day Job

Location of Job: US:NC: Raleigh

Exempt From Overtime: Exempt: Yes

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Heath Care System. This is not a State employed position.

Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email if you need a reasonable accommodation to search and/or to apply for a career opportunity.