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Employment Type:

Full time

Shift:

Day Shift

Description:

Directs Trinity Health's system-wide Central Verification/Center for Practitioner Information ensuring an efficient and effective operation in compliance with various regulatory agencies (CMS, TJC, NCQA, HFAP, DNV, etc.). Leads process improvement and implementation of evidence based, and best practice standards for system-wide credentialing verification and re-credentialing/privileging for RHMS, ACOs, CINs, PNO and delegated Health Plans as well as Provider Enrollment. Directs, organizes, monitors and analyzes operations and integration of standardization to meet system, legal, regulatory and accreditation requirements for both RHMs and Population Health entities. Develops strategic initiatives and implementation strategies for effective and efficient credentialing, privileging, provider data management, medical staff bylaws, policies, procedures, and verification functions supporting credentialing and privileging within Trinity Health and its Regional Health Ministries (RHMs) including NCQA certified delegated credentialing and Provider Enrollment.

ESSENTIAL FUNCTIONS

Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.

Directs the Trinity Central Verification Office/Center for Practitioner Information including initial and re-application credentialing responsibilities for Trinity Health's RHMs, CINs, ACOs, PNOs and other healthcare entities as appropriate such as delegated Health Plans, and managed care organizations. Develops and manages the department budget, controls staffing levels for appropriate operation, identifies reduction of duplication work effort, and ensures operation within budget. Creates and reviews weekly, monthly, annually and special reports to ensure conformance with departmental goals and regulatory requirements.

Establishes staffing plan and manages human resources necessary to ensure an efficient credentialing operation (including hiring, orientation, training, performance management, and establishment of department goals). Provides appropriate in-service of regulatory and credentialing standards, evaluates procedures, and facilitates continuing educational opportunities for staff. Plans office staff activities and work projects; supervises personnel to carry out and complete specific projects and duties.

Directs the activities required to maintain an NCQA certified and a quality provider network through appropriate activities as specified in the policy and procedure manual and delegated credentialing agreements regarding initial credentialing and re-credentialing.

Develops and implements process changes to improve the credentialing function. Contributes to the safety and quality care of patients through the accurate and timely credentialing and re-credentialing of over 25,000 medical staff members and 16,000 members of our accountable care organizations.

Directs the financial viability of Trinity Health and their practitioners through facilitating delegation with commercial payers.

Oversees the maintenance of the credentialing database to ensure a reliable source of practitioner physician information and privileges.

Implements and oversees NCQA, TJC and Trinity Health certified policies and procedures to ensure deliverable services to various key users (RHMs, CINs, ACOs, and MCOs with delegated credentialing agreements).

Develops and maintains positive working relationships with RHM, Health Plan and System Office customers.

Develops and implements processes or reviews and revises current credentialing policies and procedures to ensure compliance with Trinity Health and MCO quality management requirements (TJC, NCQA, NPDB, etc.). Establishes implementation strategies for centralized credentialing and re-credentialing verification processes.

Leads the development and implementation of standardization and consistencies in practitioner data and verification elements for each RHM, ACO, etc.

Facilitates maintenance of present facilities, office equipment, contracted services, etc. Assumes responsibility for performance of job duties in the safest possible manner, to ensure personal safety and that of coworkers who are on-site and in remote locations, and to report all preventable hazards and unsafe practices immediately to management.

Establishes and maintains an appropriate customer satisfaction standard; encourages constructive and cooperative conflict resolution; promotes positive customer relationships. Promotes and leads collaborative relationships with RHM, CIN, ACO, MPPS administrative staffs, MCO support staff, and internal department staff for a smooth and effective credentialing and re-credentialing operation.

Establishes monthly performance metrics reporting to continuously monitor the performance of the CPI Staff and achievement of overall Department objectives.

Ensures compliance with requirements once delegation has been achieved with a payer so continued delegation status is achieved and maintained.

Oversees generation of regular reports that provide monitoring of the effectiveness and efficiency of the payer credentialing and plan participation process. Identifies key issues and problems in the process and provides reports, including recommendations to the Director of Medical Staff Services or Senior Vice President.

Participates in professional development programs to ensure continued professional growth in the health care industry and maintains professional affiliations to keep abreast of trends, changes, regulations, and legislation in health care environment.

Maintains good rapport and cooperative relationships. Approaches conflict in a constructive manner. Helps to identify problems, offer solutions, and participate in their resolution.

Maintains the confidentiality of information acquired pertaining to patient, physicians, colleagues, and visitors to Trinity Health RHMs. Utilizes and discusses physician, colleague, patient and customer information only among appropriate personnel in appropriately private places including use of computers, scanners, copiers, printers and telephones

Serves as a resource to Medical Staff Offices, ACO and Physician Organization Leadership, Administrative representatives, physicians, contracting and other personnel and ensure credentialing verification and provider enrollment operations meet governmental and regulatory agency standards.

Maintains a working knowledge of applicable Federal, State and local laws/regulations; the Trinity Health Integrity and Compliance Program and Code of Conduct; as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.

LEADERSHIP COMPETENCIES

As a Trinity Health Leader, the incumbent is expected to demonstrate leadership traits which support our Mission Statement and Core Values as identified below:

**Mission Statement:** We, Trinity Health, serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities.

Core Values:

+ **Reverence:** We honor the sacredness and dignity of every person.

+ **Commitment to Those who are Poor:** We stand with and serve those who are poor, especially those most vulnerable.

+ **Justice:** We foster right relationships to promote the common good, including sustainability of Earth.

+ **Stewardship:** We honor our heritage and hold ourselves accountable for the human, financial and natural resources entrusted to our care.

+ **Integrity:** We are faithful to those we say we are.

MINIMUM QUALIFICATIONS

Must possess a comprehensive knowledge of credentialing and privileging as normally obtained through a Bachelor’s degree or an equivalent combination of education and experience. Certified Professional Medical Services Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS) required. NCQA and advanced health field degree preferred.

In depth knowledge and experience in the organization and delivery of medical staff services. Seven (7) to ten (10) years demonstrated successful experience working with medical staff and health care leadership in hospital, physician, health network and/or health plan management.

Experience with budgets in excess of $2.5M and management of large onsite and remote staffing

In depth knowledge and experience in the complex enrollment process in government and commercial health plans.

Demonstrated ability and extensive experience in planning, conducting and executing major projects and strategies including defining program, process or business objectives and scope. Demonstrated expertise to identify and evaluate opportunities, improvements, needs and gaps, planning and implementation steps. Understands stakeholder interest and provides authoritative and advisory consultation and recommendations at all levels of the organization.

Exceptional interpersonal, communications and relationship building skills with proven ability to initiate and develop productive, collaborative partnerships with physicians, management and associates. Effective supplier/consultant interface and management abilities.

Ability to drive positive results in difficult situations and effectively respond to multiple, ever-changing, competing priorities. Exceptional facilitation skills to lead and influence diverse member interests, teams and groups. Ability to shape results, garner support and successfully manage complex relationships within and across the organization.

Strong analytic and database management skills and knowledge.

Ability to operate in an ambiguous and matrix organizational structure, an autonomous, self-directed environment and with frequently changing structures, requirements and work priorities. Must possess a personal presence that is characterized by honesty, integrity and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, values and guiding behaviors of Trinity Health.

PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS

Must be available to travel to the various Trinity Health sites and national educational resource locations as needed.

**Hourly Pay Range** : $59.67 - $98.45

_The above statements are intended to describe the general nature and level of work being performed by persons assigned to this classification. They are not to be construed as an exhaustive list of duties so assigned._

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

EOE including disability/veteran