Manager Med Staff Services - Medical Staff… at Sky Lakes… · Klamath…

QUALIFICATIONS

Required: Bachelor's degree in healthcare administration, business administration, or a related field, or an equivalent combination of education and experience. Minimum of five (5) years of progressively responsible experience in medical staff services, credentialing, healthcare administration, or a related healthcare operations field, including at least two (2) years in a leadership or supervisory role. Demonstrated leadership, communication, organizational, and problem-solving skills, with the ability to effectively mentor staff and collaborate with Medical Staff and hospital leadership. Comprehensive knowledge of Medical Staff governance, credentialing and privileging practices, Medical Staff Bylaws, accreditation standards, and applicable regulatory requirements. Knowledge of provider enrollment and payer credentialing processes preferred. Proficiency in Microsoft Office Suite and Medical Staff credentialing software (e.g., MD-Staff). Ability to exercise sound judgment, maintain strict confidentiality, manage sensitive information, and effectively prioritize competing responsibilities in a fast-paced healthcare environment.

License/Reg/Cert: Certification by the National Association Medical Staff Services (NAMSS) as a Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) is preferred. Candidates who do not hold a certification at the time of hire must be eligible for certification and obtain the CPCS or CPMSM credential within one year of meeting certification eligibility requirements.

TYPICAL PHYSICAL/MENTAL DEMANDS

Light physical demand level capabilities required. Demonstrates professionalism, emotional maturity, and the ability to maintain composure while working in a fast-paced environment with frequent interruptions, competing priorities, and changing deadlines. Establishes and maintains positive working relationships with Medical Staff, hospital leadership, employees, and external stakeholders. Demonstrates strong organizational, communication, and problem-solving skills, with the ability to effectively manage a demanding workload and exercise sound judgment and discretion when handling sensitive and confidential information.

ESSENTIAL JOB FUNCTIONS

Credentialing and Privileging:

• Oversees credentialing, privileging, recredentialing, and reappointment activities and provides direct support with complex applications, investigations, and verification activities as needed to ensure timely and compliant processing.

• Oversees and ensures the integrity, quality, and regulatory compliance of credentialing, recredentialing, privileging, and reappointment processes, including high-level quality assurance review of credentialing files prior to presentation to the Credentials Committee, Medical Executive Committee (MEC), and Governing Board.

• Analyzes provider clinical backgrounds, competency information, and performance data, identifies potential concerns or discrepancies, validates findings, and communicates recommendations to Medical Staff and hospital leadership to support quality and patient safety.

• Ensures the accuracy, integrity, and effective utilization of credentialing and privileging database systems.

• Manages the Focused Professional Practice Evaluation (FPPE) process and collaborates with the Quality Department on Ongoing Professional Practice Evaluation (OPPE) activities in accordance with Medical Staff Bylaws and peer review requirements. Participates in the development, implementation, and ongoing optimization of systems and processes supporting provider competency assessment and performance evaluation.

• Oversees the development, maintenance, and standardization of privileging criteria to ensure alignment with specialty requirements, regulatory standards, and industry best practices.

• Collaborates with the Quality Department to maintain quality and performance data necessary for credentialing, recredentialing, and ongoing competency assessment activities.

Medical Staff Department/Committee Support:

• Oversees and coordinates Medical Staff committee meetings, ensuring accurate documentation of minutes, agendas, committee actions, and policy updates.

• Provides operational and administrative support to the Medical Executive Committee (MEC), including agenda development, meeting preparation, follow-up of committee actions, policy implementation, and maintenance of governance records.

• Serves as a resource to the Medical Staff President, Credentials Committee Chair, Department Chairs, other Medical Staff leaders, and hospital leadership regarding governance processes, Medical Staff Bylaws, committee actions, elections, and Medical Staff operations.

• Provides support to the Bylaws Committee in reviewing, updating, and preparing revisions to Medical Staff Bylaws, policies, and Rules & Regulations for approval by the Medical Staff and Governing Board.

Department Leadership and Oversight:

• Manages staff performance through training, mentoring, coaching, performance evaluations, and corrective action processes, and assists the Director of Medical Staff Services with hiring and termination decisions.

• Monitors departmental operations and emerging issues, proactively identifying risks, escalating concerns to leadership, and providing recommendations to support effective decision-making and regulatory compliance.

• Represents the Medical Staff Services Department and serves as a subject matter expert on Medical Staff governance, credentialing, privileging, and the interpretation and application of Medical Staff governing documents.

• Oversees Medical Staff administrative functions, including elections, dues collection, physician stipends, and Medical Staff fund administration, ensuring accurate financial management and compliance with Medical Staff policies and governing documents.

• Prepares, analyzes, and distributes Medical Staff and regulatory reports, including compliance, performance, and attestation reporting, to support organizational decision-making and regulatory requirements.

• Oversees new provider orientation and onboarding activities and continuously seeks opportunities to improve the onboarding experience.

• Oversees the Continuing Medical Education (CME) program, ensuring compliance with accreditation requirements, effective administration of CME activities, and collaboration with internal and external stakeholders to support ongoing professional development.

• Maintains professional knowledge and expertise through participation in professional organizations, continuing education, conferences, publications, and industry best practices.

• Collaborates with the Director of Medical Staff Services to develop and monitor the annual Medical Staff Services operating budget, ensuring expenses remain within budgetary guidelines.

• Supports ongoing accreditation and regulatory compliance efforts by monitoring Medical Staffrelated requirements, coordinating documentation, facilitating corrective action activities, and assisting with survey readiness and response efforts.

• Represents the Medical Staff Services Department during hospital leadership meetings, accreditation surveys, and regulatory reviews.

Provider Enrollment and Payer Credentialing:

• Provides oversight of provider enrollment, revalidation, maintenance, and termination activities with Medicare, Medicaid, commercial payers, and delegated credentialing organizations.

• Ensures compliance with payer enrollment requirements, state and federal regulations, and applicable accreditation standards.

• Collaborates with Revenue Cycle, contracting, clinical operations, and payer representatives to support timely provider onboarding and resolution of enrollment-related issues affecting reimbursement.

• Monitors enrollment operations and workflows, identifies barriers to reimbursement, and implements process improvements to enhance efficiency and reduce delays.

• Oversees the maintenance of provider enrollment records, roster submissions, delegated credentialing requirements, and payer audit readiness.

• Provides leadership, guidance, and support to enrollment staff regarding regulatory requirements, payer policies, and credentialing-enrollment integration.

MARGINAL JOB FUNCTIONS

• Performs other duties as assigned.