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What Will I be Doing in this Role?

The Credentials Evaluation Analyst provides guidance and support to medical staff leadership in the evaluation of credentials and practice information as it relates to the granting of clinical privileges. Contributes to the planning, structuring and monitoring of credentialing activities, and assists with high-profile/sensitive credentialing projects. Works in collaboration to implement standard processes, recommend policy/procedure changes and provide input about work products.

Collaborates with Credentialing Logistics and Information Department - Evaluates individual practitioner credentials files (both electronic and paper files) to ensure that information received from the Credentials Coordinators/Credentials QC Analysts meets established specifications. Pursues additional information as necessary. Investigates issues of concern in cooperation with applicable individuals and/or departments.

Advances and makes recommendations to resolve issues that do not conform to established expectations to Credentialing Manager or consultation with other appropriate partners, as required.

Identifies/Flags Potentially Adverse Information - Assesses practitioner files to determine the presence or absence of potentially adverse or incomplete information that may impact medical staff membership or privileging decisions in accordance with established criteria. Pursues problematic, missing or incomplete information in conformance with established procedures. Summarizes the results of the assessment in the file audit summary report.

Evaluation of Credentials /Qualifications Against Privileging Criteria - Assesses data/information provided against criteria for privileges requested and recommend actions for resolution. Pursues problematic, missing or incomplete information in conformance with established procedures. Summarizes the results of the assessment in the file audit summary report.

Communication - Maintains lines of communication on work products and evolving issues of concern with regard to applicants/re-applicants with medical staff leadership, Credentials QC Analysts/Coordinators, clinical department managers and Clinical Privileging Quality Manager, as applicable.

Interview Coordination – Coordinates completion of interview for initial applicants. In accordance with the New Applicant Work Process (Jobs & Tasks) conducts follow-up as prompted by task list. Follows-up with interviewer to facilitate completion of Interview Summary & Recommendation form. Coordinates any additional follow-up necessary to resolve areas of concern.

Support of Practitioner Evaluation – Serves as a liaison and provides support for the divisional review, department chair review and pre-Credentials Committee review (as applicable) of both initial applicants and applicants for renewal. Facilitates a detailed and comprehensive evaluation as related to granting, continuing, denying or rescinding privileges.

Collaboration with Patient Safety and Peer Review Department -- Collaborates with applicable individuals regarding related competency management activities associated with Ongoing Professional Practice Evaluation (OPPE) to promote the identification of professional practice trends that impact quality of care and patient safety. Ensures that the results of these evaluations are considered by division chiefs and department chairs when recommendations regarding continued privileging occur. Sends notification of conditional appointments/privileges to Quality Improvement department and tracks for compliance

Acts as a resource - Provides expert internal consultation and facilitation to partners regarding credentialing and privileging matters related to assigned specialties.

Facilitates completion of Focused Professional Practice Evaluation (FPPE) for practitioners in assigned specialties whenever new privileges are granted. Ensures that the results of these evaluations are considered by division chiefs and department chairs as they confirm clinical competence. Collaborates with the Patient Safety and Peer Review Department when the medical staff organization determines that focused review of an individual's clinical practice is required due to potentially adverse information.

Identifies and works to implement best practices. Makes recommendations to policy/procedure changes.

Works to resolve issues related to high-profile and sensitive credentialing projects with the help of the privileging manager.

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Requirements:

• High School Diploma/GED required. Bachelor’s degree in credentialing/privileging or related major preferred. Closely related health care position with demonstrated knowledge of medical terminology and clinical nomenclature preferred. 
• Clinical credentials (i.e., Registered Nurse) preferred.
• Certification or eligibility for Certification by the National Association of Medical Staff Services (NAMSS) as a Certified Medical Staff Coordinator (CMSC) or Certified Provider Credentialing Specialist (CPCS) preferred or attained within two (2) years of hire date.

Experience/Skills We are Seeking:

• Proficiency in software applications to include use of menu driven, word-processing and spreadsheet applications. Ability to draft business correspondence and ensure correct punctuation, spelling and grammar. Ability to perform simple mathematical calculations.
• Ability to interact effectively with Medical Staff Leadership, Senior Management, Directors, Managers, Physicians, internal staff and representatives of public agencies and businesses inspiring confidence and credibility of process and work products.
• Ability to manage multiple priorities and/or projects and tasks in a fast-paced, dynamic and complex environment. Flexibility to accommodate unstructured situations and changing priorities.
• Demonstrated ability to handle multiple tasks with short timelines, to prioritize and organize work, and to complete assignments in a timely, accurate manner.
• Ability to work independently and use independent judgment while providing excellent service.

Why Work Here?

Beyond outstanding employee benefits including health and dental insurance, vacation, and a 403(b) we take pride in hiring the best employees. Our accomplished staff reflects the culturally and ethnically diverse community we serve. They are proof of our commitment to creating a dynamic, inclusive environment that fuels innovation.