As seen on JobsInME.com
Medical Staff Services Manager
Spectrum Healthcare Partners | South Portland, ME
Position is responsible for the medical-administrative and medical-legal aspects of the Medical Staff organization at Spectrum Healthcare Partners. Establishes and maintains continuity in the planning, development and implementation of standards applicable to Medical Staff Members and Allied Health Professionals relating to appointment, credentialing and organized Medical Staff activities. Provides supervision of personnel who staff the Medical Staff Services Office and provides oversight for all Department/Committee meetings, credentialing activities, privileging, payor enrollment, continuing medical education, and investigational studies, as appropriate, in accordance with the federal, state, and accreditation standards and regulations.
Credentialing and Payor Enrollment teams
- Assists Medical Directors in the pursuit of their responsibilities as defined in the Medical Staff Bylaws, and Rules/Regulations
- Monitors site-specific Medical Staff Bylaws/Rules & Regulations, and makes recommendations for revisions to keep them current and in compliance with state and federal standards and regulations, as well as reflective of the current practice at each site.
- Maintains primary responsibilities for the direction and coordination of all medical staff support services, monitoring functions, credentialing, re-credentialing, privileging, peer review, payor enrollment, maintenance of certification support and medical education.
- Works collaboratively with the Quality Department to establish and maintain work flows for provider competency (review) committee activities such as privileging, OPPE/FPPE reporting and other practitioner-based requirements for the Company as well as hospital and surgery center requirements
- Implements and oversees adherence to medical staff support services policies and procedures. Maintains personal adherence to professional and confidentiality standards established with the department and in accordance with legal, ethical, and internal policies
- Drives performance management for credentialing staff, including work efficiency and prioritization of work to ensure all providers are privileged prior to initiating work. Maintains communications and provides reports to meet delegated credentialing and payer enrollment obligations.
- Ensures the effective onboarding and training of new staff members. Identifies ongoing training and development opportunities for new and existing team members
- In coordination with Quality and Clinical Compliance, maintains knowledge of new and changing accreditation, licensing, and educational requirements and assists in their implementation. Participates in the continuous readiness program for various accreditations across the Company, to include The Joint Commission and AAAHC.
- Coordinates, arranges, and staffs medical staff department and committee meetings. Records and transcribes meeting minutes and performs follow-up as required
- Maintains department data applications to support the core activities and works closely with IT/Development team to seek opportunities to improve efficiency and reporting to the providers and operational units
- Identifies opportunities for using technology to gain efficiencies and automation for supporting the work of the Medical Staff Services team.
- Performs ongoing assessment of the department’s organizational structure and alignment to meet forecasted business needs for The Company
- Performs other job-related duties as assigned by the Director of Quality
- Attend and participate in meetings as assigned, during and after normal business hours
- Participate in educational activities to keep skills up to date
- Support Company-wide strategic initiatives
- Ensure development of strong positive relationships and collegiality among the practice and organization’s resources and staff
- Demonstrate professionalism at all times
- Displays cooperative behavior and interacts positively and effectively with others to promote a team environment
- Performs other duties necessary to maintain the overall efficiency and continuity of the department
- Is proactive in identifying, reporting and participating in the resolution of any potential or actual patient safety issues
- Bachelor’s degree or equivalent in experience
- Certification in Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM)
- Five+ years of healthcare related experience or compliance management
- Detailed understanding of accreditation and government requirements/expectations for healthcare compliance programs
- Familiarity with Medicare and Medicaid programs and state insurance laws preferred
- Experience in healthcare administration, risk management, compliance, and/or healthcare quality
- Demonstrated effectiveness operating in complex organizational environments
- Proficient in the use of computer software programs to include Microsoft Word, Excel, PowerPoint and database/intranet research skills
- Demonstrated leadership abilities
- Excellent customer service, interpersonal and listening skills
- Excellent written and oral communication skills with the ability to communicate effectively with all levels of the organization
- Ability to interface with physician leadership and provide appropriate counsel
- Strong PC skills especially with the Microsoft Office suite (Word, Excel)
- Ability to maintain confidentiality
PHYSICAL DEMANDS / WORK ENVIRONMENT
- Operation of various office equipment: fax machine, telephone and voice mail system, personal computer, e-mail system, cell phone, pager, and photocopier
- Occasional travel to and from various sites of service
- May be required to sit or stand for long periods of time
- Filing and light lifting, reaching