Manager, Ambulatory Credentialing, Sutter Health, Northern CA

Posted on March 27th, 2025

Job Posting Title:  Manager, Credentialing

Job Description Summary
Oversees the day-to-day operations and provides oversight of work assigned to the credentialing team. Responsible for managing work assignments, monitoring established goals, coaching and establishing performance plans. Performs routine audits to ensure compliance with department policies and Federal/State requirements. Takes a strategic and tactical approach in identifying best practices and standardizing workflows/processes and developing plans of action to implement changes.

Job Description

EDUCATION:

Equivalent experience will be accepted in lieu of the required degree or diploma.

Bachelor's: Business Administration, Healthcare or related field or equivalent education/experience

TYPICAL EXPERIENCE:

8 years recent relevant experience

SKILLS AND KNOWLEDGE:

• Must have knowledge of credentialing principals, particularly those associated with medical groups and insurance.
• Ability to oversee day-to-day credentialing and enrollment activities to ensure business goals are met.
• Requires the ability to work with and maintain confidential information.
• Proficient in Microsoft Word, Excel, Access and PowerPoint and Credentialing systems and applications.
• Ability to navigate credentialing information management systems to perform analysis and generate reports as needed.
• Demonstrated leadership skills, including team building, and coaching/mentoring with the ability to motivate and engage others.
• Ability to build and establish effective working partnership with employees, peers and/or leaders to achieve business objectives.
• Organizational and time management skills, with the ability to prioritize multiple projects while delivering quality service and achieving business results.
   

Strategy/Planning

• Maintains expertise by reading journals, manuals, articles and attending seminars or workshops pertaining to credentialing, enrollment and management. This is critical in order to maintain up-to-date awareness and understanding of applicable rules, regulations and standards required to maintain compliance.
• Stays abreast of the latest developments, best practices and trends in credential verification and other functional areas that may impact the organization and ensures appropriate implementation within the organization.
• Utilizes reporting tools to gain operational insight in order to identify and manage problems and propose resolutions
• Leads departmental goal setting process and provides roadmap for accomplishing goals. Monitors progress, developing action plans to address issues and challenges.
• Communicates affiliate, operating unit and system goals to staff, helping staff understand impact on operations and resources.
• Develops plan of action to address current and future resource needs in order to meet service and/or operational demands and objectives.

Financial Management

• Establishes and manages capital and operational budgets to achieve financial targets via effective utilization of personnel, resources and supplies.
• Monitors department productivity, ensuring operational challenges are addressed timely.
• Reviews financial reports and develops and implements corrective action plans to address unfavorable variances.

People

• Provides and fosters an inclusive work environment that encourages staff engagement and collaboration, establishing a culture of teamwork.
• Supervises assigned staff, makes hiring and termination decisions, and reviews and approves timekeeping records.
• Establishes expectations with all direct reports, holds individuals and work teams accountable, and ensures job descriptions accurately reflect job responsibilities and expectations.
• Evaluates staff performance and makes/recommends associated merit increase. Provides constructive feedback, coaching and counseling.
• Provides opportunities for career development, role expansion, and cross-training.
• Monitors department training and orientation plans, ensuring staff meets competency requirements and participates in appropriate education and training programs.
• Conducts staff meetings for informative and educational purposes.

Compensation: Salaried position (range 104-160k depending on experience), 401k matching, Annual Bonus, Full benefits

Link to Apply:  https://wd1.myworkdaysite.com/recruiting/sutterhealth/SH/job/Los-Altos/Manager--Credentialing_R-97198

Medical Staff Coordinator, City of Hope National Medical Center, Duarte, CA

Posted on March 13th, 2025

Position Summary:

Under minimal supervision, assists the Department’s Director/Manager in the coordination of Medical Staff activities consistent with City of Hope’s philosophy, mission, vision and strategic plan.

Responsibilities include but are not limited to: Coordination of Medical Staff activities for assigned Department/Committee meetings; performs credentialing/re-credentialing/privileging of Medical Staff Members and Allied Health Practitioners as assigned; responsible for relevant ongoing and focused professional practice evaluations (OPPE/FPPE) activities; and acts as liaison between the Medical Staff, Nursing Administration, and the Governing Board.

Essential Functions:

Duties & Responsibilities

• Coordinates Medical Staff activities for assigned Department/Committee meetings and acts as liaison between the Medical Staff, Nursing, Administration and the Governing Board.
• Schedules, coordinates, prepares agenda, takes accurate minutes, provides follow up for assigned Medical Staff clinical Departments/Committees recommendations and acts as a resource of information concerning medical staff issues.
• Follows through on all Department, Division and Committee recommendations and correspondence in a timely manner and channels communication between Medical Staff meetings.
• Maintains close communication with Medical Staff Officers, Chairs and Chiefs to ensure expeditious follow-through with Department/Division and Committee meeting actions and changes in policies.
• Provides the Medical Staff President, Medical Staff Officers, Chairs/Chiefs, and Administration with information of problems identified in their areas.
• Maintains current knowledge and interpretation of recommendations and standards by TJC, CMS, NCQA, State, and other regulatory agency standards. 
• Maintains close communication with CME Department in the coordination of educational activities resulting from Department/Committee meetings thus creating a positive linkage between performance improvement and CME.
• In the absence of the Director/Manager, oversees the daily functions of the Department and maintains close communication with the President of the Medical Staff, the Department’s Vice President, Administration, and Chairs/Chiefs, to keep them informed of problems, issues, and concerns within their areas.
• Responsible for follow-through of OPPE and FPPE requirements for assigned Departments/Divisions.
• Coordinates with the Director/Manager, QRRM, in preparing for, and attending accreditation surveys.
• Follows established City of Hope and department policies, procedures, objectives, performance improvement, attendance, safety, environmental, and infection control guidelines.  Practices a high level of integrity and honesty in maintaining records and confidentiality.
• Performs summary reports of credentialing/re-credentialing/privileging functions as assigned.
• Generates queries and reports from the credentialing and privileging database. Assists with clinical privilege development and maintenance of the privileging database.
• Prepares for the Governing Board a monthly report of Medical Staff activities as reviewed by the Medical Staff Executive Committee, as applicable.
• Conducts audits of credentials files.
• Handles telephone calls; exercises judgment as to the urgency or other nature of the calls; directs calls to appropriate personnel.
• Responsible for tracking and monitoring of proctoring requirements.
• Collects Annual Medical Staff Dues.
• Process check requests for expenses incurred within the Department in accordance with budgetary guidelines.
• Prepares the monthly Treasurer’s Report to the MEC and to the General Medical Staff.
• Generates medical staff reports as requested (e.g., rosters, lists of physicians on staff, etc.).
• Follows established City of Hope and department policies, procedures, objectives, performance improvement, attendance, safety, environmental, and infection control guidelines, including adherence to the workplace code of Conduct and Compliance Plan.
• Practices a high level of integrity and honesty in maintaining confidentiality.
• Performs other related duties as assigned or requested.

Minimum Education:

• Associate degree, 18 months of additional experience plus the minimum experience requirement may substitute for minimum education. High School or GED.

Minimum Experience:

• 3 years’ experience as a Medical Staff Coordinator or similar and relevant experience.

Required Courses/Training:

• Courses in medical terminology, business English, English Composition, typing course.

Req. Certification/Licensure:

• Certification from the National Association of Medical Staff Services as Certified Provider Medical Staff Management (CPMSM) or working towards achieving certification within 2 years of employment.

Preferred Education:

• Bachelor’s degree.

Skills/Abilities:

• Proven ability to apply external regulatory guidelines and internal accounting and administrative policies.
• Ability to independently set and meet deadlines while multi-tasking and assigning precedence to competing priorities.
• Ability to see multiple assignments through completion of deadlines.
• Excellent oral/written communication and organizational skills.

Software:

• Ability to perform all commonly applicable functions in Microsoft Office Suite (Word, Excel, PowerPoint).

Machines/Equipment:

• Advanced competency in a paperless credentialing database system and understanding of provider data integrity standards (credentialing and privileging software, Adobe Professional, document scanning/storage, web-based applications, Zoom, Teams, etc.)

Working/Environmental Conditions:

• Atmosphere and environment associated with an office setting.

Physical Demands:

• Light physical effort (lift/carry up to 10 lbs)
• Mostly sedentary work
• Occasional standing/walking
• Occasional reaching, stooping, bending, kneeling, crouching

Qualified candidates may apply online at:

Administrative Support Job: Medical Staff Coordinator at City of Hope in Duarte, CA

Credentialing Specialist, Keck Medicine of USC, Los Angeles, CA

Posted on March 1st, 2025

Keck Medicine of USC

Keck Medicine of USC is the University of Southern California’s medical enterprise, one of only two university-based medical systems in the Los Angeles area. Keck Medicine combines academic excellence, world-class research and state-of-the-art facilities to provide highly specialized care for some of the most acute patients in the country.

Our internationally renowned physicians and scientists provide world-class patient care at Keck Hospital of USC, USC Norris Cancer Hospital, USC Verdugo Hills Hospital, USC Arcadia Hospital and more than 100 unique clinics in Los Angeles, Orange, Kern, Tulare and Ventura counties.

Keck Medical Center of USC, which includes Keck Hospital and USC Norris Cancer Hospital, is among the top 50 hospitals in the country in eight specialties, as well as the top three hospitals in metro Los Angeles and top 10 hospitals in California, according to U.S. News & World Report’s 2022-23 Best Hospitals rankings.

Credentialing Specialist - Office of Integrated Credentialing - Full Time 8 Hour Days (Exempt) (Non-Union)

Keck Medicine of USC
Hospital
Los Angeles, California

The Credentialing Specialist is responsible for maintaining the quality and reliability of the collection and verification of practitioner applicants professional qualifications. The Credentialing Specialist completes initial and ongoing quality audits while providing constructive feedback. Additionally, the Credentialing Specialist is responsible for data analysis, action plan development and assisting in the establishment and achievement of business objectives in affiliation with all Keck Medicine of USC entities and clients.

Essential Duties:

• Responsible for the audit of the Credentialing processes. Audits 100% of credentialing and re-credentialing files and data entered into the Credentialing Database, of all Keck Medicine of USC entities and clients processed by the USC Office of Integrated Credentialing.
• Conduct audits to verify compliance with established business processes and that an effective system of internal controls is in place. Audit and monitor data, systems, and processes to ensure compliance with relevant accreditation and regulatory standards and internal policies and procedures.
• Assist in development and implementation of corrective action plans.
• Conduct mock audits and to assist in development of corrective action plans to address any identified issues
• Assist in the development of processes and procedures to verify credentialing elements such as education, training, board certification, work history, licensure, and certifications.
• Ensure business processes are performing within desired standards. Evaluates that applications are properly verified and uploaded into the online credentialing database system.
• Works with Manager or Director of the entity to prepare credentialing and re-credentialing files for accreditation surveys, mock surveys, pre-delegation and delegation surveys.
• Returns audited files showing any oversight to the relevant credentialing coordinator who originally prepared the file, for the purposes of data correction, education and coaching.
• Provides audit reports and conducts analysis including trend identification, and opportunities for improvement in order to provide individual and department level performance improvement plans. Ensure data is accurate, consistent, complete, and valid according to established standards.
• Demonstrates leadership skills and sets an example of personal performance which encourages excellence in integrity.
• Communicates clearly and concisely using strong decision making skills.
• Adheres to established guidelines as defined by Entity/Department policies.
• Maintains current knowledge of computers, systems, and applications that impact operations of Credentialing.
• Keeps current with TJC, DNV, NCQA, CMS, AAAHC and other applicable state and federal Credentialing regulations and guidelines.
• Maintains current knowledge of Credentialing and auditing industry trends.
• Independently make decisions regarding whether information meets OIC, TJC, NCQA, DNV, Title 22, and CMS and relevant bylaws/Credentialing Plan requirements related to content, completeness and timeliness.
• Ensures maximum confidentiality, accuracy, security, and appropriate access of all data and records, and provides maximum protection from discoverability of all information.
• Performs other duties as assigned.

Required Qualifications:

• Req Bachelor's degree in related field
• Combination of experience/education may substitute for minimum education requirement
• Req 3-5 years 3-5 years’ experience as a credentialing professional
• Req Ability to plan own schedule, set priorities and work independently in accomplishing work assignments on time.
• Req Knowledge of Joint Commission, DNV, AAHC, and NCQA standards, Title 22, and CMS regulations pertaining to the organized medical staff, required
• Req Knowledge of medical staff principles, practices, quality assessment, performance improvement functions, and legal concepts related to the organized medical staff, required
• Req Effective analytical and critical thinking verbal and written communication skills.
• Req Proficiency in use of MD-Staff, related applications/internal systems to collect information necessary to complete principal accountabilities.

Preferred Qualifications:

• Pref Certified Professional in Medical Services Management (NAMSS) Valid CPMSM or CPCS certification by the National Association of Medical Staff Services strongly preferred

Required Licenses/Certifications:

• Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)

The annual base salary range for this position is $81,120.00 - $133,010.00. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.

REQ20159442 Posted Date: 02/10/2025

Interested candidates apply online at:

https://usccareers.usc.edu/job/los-angeles/credentialing-specialist-office-of-integrated-credentialing-full-time-8-hour-days-exempt-non-union/1209/77309840912

Medical Staff Coordinator, Senior - Keck Medicine of USC, Glendale, CA

Posted on February 25th, 2025

Keck Medicine of USC

Keck Medicine of USC is the University of Southern California’s medical enterprise, one of only two university-based medical systems in the Los Angeles area. Keck Medicine combines academic excellence, world-class research and state-of-the-art facilities to provide highly specialized care for some of the most acute patients in the country.

Our internationally renowned physicians and scientists provide world-class patient care at Keck Hospital of USC, USC Norris Cancer Hospital, USC Verdugo Hills Hospital, USC Arcadia Hospital and more than 100 unique clinics in Los Angeles, Orange, Kern, Tulare and Ventura counties.

Keck Medical Center of USC, which includes Keck Hospital and USC Norris Cancer Hospital, is among the top 50 hospitals in the country in eight specialties, as well as the top three hospitals in metro Los Angeles and top 10 hospitals in California, according to U.S. News & World Report’s 2022-23 Best Hospitals rankings.

Medical Staff Coordinator, Senior - Office of Integrated Credentialing - Full Time 8 Hour Days (Non-Exempt) (Non-Union)

Keck Medicine of USC
USC Verdugo Hills Hospital
Glendale, California

The Senior Medical Staff Coordinator provides administrative support and acts as liaison to committees, physicians and other medical staff department members ensuring all medical staff issues are appropriately handled by various committee chairs, and medical staff members. Mentors and assists other Medical Staff Coordinators in all aspects of Medical Staff functions.

Essential Duties:

• Serves as medical staff department lead and serves as subject matter expert for medical staff functions. Initiates and participates in cross-training and cross-coverage of departmental functions. Serves as departmental resource to employees.
• Management of the Credentials and Interdisciplinary Practice Committees, including agenda, minutes, file audits, follow-up communication with management and Office of Integrated Credentialing, correspondence, referrals to other committees/departments and all related follow-up within three days of the meeting. Review of monthly Governing Board report and quality check of provider’s approved credentials/privileges.
• Develop and maintain VHH facility credentials checklist and audit tools
• Oversee the coordination and staffing of Medical Staff Committees, as needed. Ensures feedback of significant Medical Staff and committee actions to the medical staff and hospital departments/committee’s affected.
• Maintains knowledge of and provides consultative support to the Chairs in the management of the Medical Staff organization in the development, revision and implementation of Medical Staff systems and procedures to ensure compliance with accreditation and regulatory requirements.
• Participates in departmental PI initiatives, including regulatory preparedness.
• Liaison between committee Chairpersons and hospital departments.
• Oversee the credentialing as it relates to proctoring. Work with the Chairman of physicians being proctored or monitored by department, and notify physician assigned to proctor of new applicants including notifications, discontinuation of proctoring and all related follow-up.
• Coordinate with quality management department and department chair on all provider proctoring and peer review activity reports of assigned committees and departments to the Performance Improvement Committee.
• Assist Director in the development of policies and procedures as it relates to Medical Staff Services.
• Develop and maintain department staff desk reference of process instructions for Medical Staff Services operations.
• Assist Director in training of new Medical Staff Services staff and Volunteers. Work with Director to develop and maintain algorithms of medical staff services processes shared with internal departments.
• Manage VHH facility provider credentialing database including report writing and implementation of new modules/initiatives.
• Liaison with external credentialing entities. Work with Office of Integrated Credentialing to maintain, share and follow-up with approval of VHH provider’s credentialing records with the external entity.
• Work with medical staff coordinator and Keck Graduate Medical Education department to coordinate, monitor and track I.D. badge issuance and meal allowance of all medical students and residents vetted to rotate at VHH.
• Assures the completeness and accuracy of the credentialing process. Coordinates the initial credentialing and privileging delineation activities and re-credentialing/re-privileging of the medical/allied health staff in accordance with the Bylaws, Rules and Regulations, and Policies of the Medical Staff and the appropriate medical staff departmental rules and regulations to assure that only qualified practitioners are appointed to provide care in the Hospital. Processes requests for and monitors duration of temporary privileges in accordance with the Bylaws, Rules and Regulations of the Medical Staff. Obtains appropriate approvals and distributes notices of temporary privileges granted.
• Maintains in a timely manner an accurate, secure and updated computerized database of physician and allied health information to query on demographic profiles including but not limited to staff privileges, proctoring and category status for other hospital departments and facilities requiring this information. Generates appropriate forms and reports available from the medical staff database. This includes monitoring the status of staff members in the Provisional and Leave of Absence categories and assures appropriate and timely review by the department chairs at the conclusion of period specified in the proctoring plan.
• Assist Director in the development, maintenance and distribution of privilege forms.
• Acts as a backup for the Director.
• Maintain the Quality Management Review results that were discussed at the meetings after the minutes and follow-up.
• Adhere to written hospital and department policy and procedures.
• Perform all other duties as assigned.

Required Qualifications:

• Req High school or equivalent
• Req 6 years Experience providing administrative/office support in an acute care facility, ambulatory center, provider practice or community healthcare organization in which duties included multiple tasks and responsibilities
• Req Excellent communication (written and verbal) skills
• Req Strong interpersonal and oral communication skills for interaction with peers, providers, nursing, administration and other internal and external staff
• Req Medical Staff/Credentialing database and / or data entry experience
• Req Critical thinking skills
• Req Analytical skills
• Req Knowledge of regulatory standards and legal concepts related to the organized Medical Staff

Preferred Qualifications:

• Pref Medical Staff Services Certification Valid CPCS or CPMSM by the National Association of Medical Staff Services (or equivalent five years experience as medical staff professional).

Required Licenses/Certifications:

• Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)

The hourly rate range for this position is $33.00 - $54.02. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.

REQ20159416 Posted Date: 02/10/2025

Interested candidates apply online at:

https://usccareers.usc.edu/job/glendale/medical-staff-coordinator-senior-office-of-integrated-credentialing-full-time-8-hour-days-non-exemp/1209/77309841056