Medical Staff Credentialing Director jobs in Hialeah, FL

Medical Staff Credentialing Director is responsible for all aspects of the verification process for medical staff incumbents. Provides regulatory oversight and guidance to the credentialing process. Being a Medical Staff Credentialing Director maintains working knowledge and ensures continuing compliance with state, federal, and institutional standards and guidelines. Develops and implements policies and protocols related to medical staff verifications and ensures that the organization and staff are in accordance with organizational and industry standards. Additionally, Medical Staff Credentialing Director analyzes reports on applications and credential status to identify trends and improve the credentialing process. Presents files to the credentialing committee and may act as a liaison to state medical licensure boards regarding the status of license applications. Requires a bachelor's degree. May require Certified Provider Credentialing Specialist (CPCS). Typically reports to senior management. The Medical Staff Credentialing Director typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. To be a Medical Staff Credentialing Director typically requires 3+ years of managerial experience. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. (Copyright 2024 Salary.com)

C
Credentialing Manager
  • Chen Medical
  • Miami, FL FULL_TIME
  • Company DescriptionChenMed is transforming healthcare for seniors. We provide big answers to big problems in health care delivery.ChenMed is a full-risk primary care market leader with an innovative philosophy, unique physician culture and end-to-end customized technology. These things allow us to provide world-class primary care and coordinated care to the most vulnerable population – moderate- to low-income seniors who have complex chronic diseases.Through our innovative operating model, physician-led culture and empowering technology, we are able to drive key quality and cost outcomes that create value for patients, physicians and the overall health system.Our model allows us to practice medicine the way it should be practiced. By recruiting focused physicians and reducing their doctor-to-patient ratios, we increase patients’ “face time” during each monthly appointment and help foster stronger doctor-patient relationships. Our model also drives and enhances compliance with treatment plans.As a result of our efforts, our patients realize lower hospital admissions. Their overwhelming response to our approach is reflected in our aggressive, organic growth and net promoter scores in the low to mid 90s, which is unheard of in any industry. Read more about our results and the value of the ChenMed model.As a company, we are making a difference in the lives of seniors and the health care system overall.Job DescriptionThe Credentialing Manager is responsible for managing a team of credentialing professionals and is accountable for systems and processes that ensure compliance with organizational credentialing policies and procedures, and compliance with the credentialing requirements of our health plan partners, and related regulatory and accrediting agency requirements. This individual will oversee the initial and ongoing application process for all clinicians and is responsible for: maintaining the organization’s credentialing databases and online systems, maintaining up-to-date credential files, and managing all health plan enrollments and reappointments, as well as, managing all initial and ongoing applications for medical staff privileges at ChenMed designated facilities. Primary Duties and Responsibilities:• Ensure compliance with ChenMed’s credentialing and recredentialing policies and procedures, and compliance with state, federal, accreditation and health plan credentialing requirements.• Collaborate with leadership on policy development and standardization of criteria / processes across the organization.• Maintain and ensure up-to-date credentialing files.• Responsible for the accuracy and integrity of credentialing files, credentialing database and reporting systems.• Monitors external credential databases, including CAQH, PECOS and other regulatory agencies, to ensure data is updated and ready for quick retrieval and use by interested parties.• Ensure credentialing files are complete before presentation to Credentialing Committee.• Provide consultation to Credentialing Committee / leadership on issues related to consideration of clinician credentials and reappointments.• Oversee compliance with health plan requirements related to delegated credentialing agreements and credentialing file audits.• Oversee processes and reviews (including ensuring resolution) all reports related to adverse actions such as sanctions, licensure actions or limitations, and credentialing-related complaints.• Interview, hire and train new staff on credentialing and recredentialing policies and procedures; also provides ongoing training as needed regarding new guidelines or updated processes / policies.• Daily monitoring of employee’s workload and various credentialing work streams (e.g. onboarding, credentialing, pharmacy, medical staff privileging, Medicare/Medicaid enrollments, Credentialing Committee meetings, health plan enrollments, etc.). • Play an important role in making decisions regarding employee’s performance issues such as the need for disciplinary counseling, performance documentation and/or termination.• Conducts periodic audits of credentialing files and staff work-product.• Oversees initial applications and reappointments for Medicare / Medicaid enrollment, hospitals, surgical centers and managed care entities for assigned divisions. • Develops and provides regular reports and presentations concerning the operation and progress of the credentialing functions, including activity related to approvals, denials and / or appeals.Other responsibilities may include:• Monitor renewals of licensure and other documents subject to expiration, and ensures updates are forwarded to facilities and healthcare partners as renewals are received.• Oversee and coordinate health plan office site visits.• Work with leadership to identify and implement best practices related to credentialing.• Responds to facilities and health plan inquiries, interfaces with internal staff and external customers on day-to-day credentialing issues.• Collaborates with leadership on submitting and maintaining up-to-date health plan rosters.• Responsible for management and supervision of credentialing staff / team.• Upon request of supervisor, attends meetings with payer representatives to address outstanding issues.• Respond to internal / external request for credentialing and licensing status.• Develop reports to present to the leadership staff as requested.• Other activities as outlined in the credentialing and recredentialing policies and procedures.• Other duties as assigned and modified at manager’s discretion.Qualifications• Bachelor’s degree in business administration or health care related field required. • Strong understanding and use of web-based credentialing applications. Experience with MDStaff preferred.• Working knowledge of NCQA, AAAHC, JCAHO, AOA, URAC and other applicable accreditation and regulatory standards• Database management skills including querying, reporting, and document generation.• Five to Seven (5-7) years of Credentialing experience required. • Two (2) year experience in a Lead/Management capacity required.• Certified Provider Medical Services Management (CPMSM) / Certified Provider Credentialing Specialist (CPCS) Certification preferred (Required to obtain certification within 6-12 months of hire).Additional Information• Advanced knowledge of Microsoft Office Software (Excel, Access, and Word), database administration and scanning applications.• Strong organizational, verbal and written communication skills.• Ability to work effectively with staff, physicians and external customers.• Ability to work independently with limited supervision.• Multi-tasking and knowing how to set priorities. • Fluent in English. EDUCATION / SPECIALIZED KNOWLEDGE REQUIREMENTS:
  • 1 Month Ago

F
Travel ASCP/AMT - Travel Med Tech - Medical Technologist
  • Focus Staff Services
  • Key West, FL OTHER
  • OverviewWe currently have a client in Key West, FL looking for a Medical Technologist (Traveling Medical Technologist)Focus Staff is seeking a traveling Certified Medical Technologist, who is responsi...
  • 1 Month Ago

L
Director, Facilities Management
  • Lower Keys Medical Center
  • KEY WEST, FL FULL_TIME
  • Dreaming of living in paradise? Want to join a team delivering unmatched patient care? Enjoy leading an incredible team? If so, we have the perfect role for you! What We Stand For: At Lower Keys Medic...
  • Just Posted

F
Diagnostic Medical Sonography Program Director (Higher Education)
  • Florida National University
  • Hialeah, FL FULL_TIME
  • Major Responsibilities: The Diagnostic Medical Sonography Technology Program Director position is responsible for assuring effective program operations. Overseeing ongoing program accreditation and as...
  • 15 Days Ago

F
Travel Nurse RN - ICU/Critical Care - $1,797 to $1,852 per week in Key West, FL
  • Focus Staff
  • Key West, FL FULL_TIME
  • Focus Staff is seeking a Intensive Care Unit Registered Nurse for a travel contract in Key West, FL. The ideal candidate will have at least 1 year of experience in a ICU setting. Contract Length: 13 W...
  • 8 Days Ago

F
Travel Nurse RN - Med/Surg - $1,567 to $1,615 per week in Key West, FL
  • Focus Staff
  • Key West, FL FULL_TIME
  • Focus Staff is seeking a Med Surg Registered Nurse for a travel contract in Key West, FL. The ideal candidate will have at least 1 year of experience in a Med Surg setting.Contract Length: 13 WeeksSta...
  • 8 Days Ago

Filters

Clear All

  • Filter Jobs by companies
  • More

0 Medical Staff Credentialing Director jobs found in Hialeah, FL area

U
Medical Director of Heart Failure in Miami, Florida
  • University of Miami Miller School of Medicine
  • Miami, FL
  • The University of Miami Health System is initiating a search for a Cardiovascular Medicine (Medical Director of Heart Fa...
  • 4/17/2024 12:00:00 AM

P
Urgent Care Medical Director
  • PetMedic Urgent Care Vet Clinics
  • Miami, FL
  • Working in an urgent care environment is as exhilarating as running a million miles an hour with sand between your paws....
  • 4/16/2024 12:00:00 AM

F
Medical Director Physician
  • Familiar Medical Center
  • Miami, FL
  • Job Description Job Description We are seeking a Medical Director Physician to become a part of our team! You will coord...
  • 4/16/2024 12:00:00 AM

C
Physician Clinic Medical Director
  • Concentra
  • Hialeah, FL
  • Overview Are you ready to take your career to new heights? At Concentra, you will be a vital member of our patient care ...
  • 4/16/2024 12:00:00 AM

P
Urgent Care Medical Director
  • Petmedic Urgent Care Vet Clinics
  • Miami, FL
  • Working in an urgent care environment is as exhilarating as running a million miles an hour with sand between your paws....
  • 4/16/2024 12:00:00 AM

M
Medical Director, FL PACE Centers
  • Miami Jewish Health System
  • Fort Lauderdale, FL
  • Miami Jewish Health is one of the largest providers of healthcare and living options for aging adults in the Southeast. ...
  • 4/16/2024 12:00:00 AM

U
Medical Director of Heart Failure in Miami, Florida
  • University Of Miami Miller School Of Medicine
  • Miami, FL
  • The University of Miami Health System is initiating a search for a Cardiovascular Medicine (Medical Director of Heart Fa...
  • 4/16/2024 12:00:00 AM

N
Medical Director - Emergency Medicine - Baptist (Homestead, FL)
  • Nicklaus Children's Health System
  • Homestead, FL
  • Description Job Summary Works closely with the leadership team to support the NCHS mission to provide amazing patient ca...
  • 4/15/2024 12:00:00 AM

Hialeah ( /ˌhaɪəˈliːə/) is a city in Miami-Dade County, Florida, United States. With the population of 239,673 at the 2018 United States Census, Hialeah is the sixth-largest city in Florida. It is a principal city of the Miami metropolitan area, which was home to an estimated 6,012,331 people at the 2015 census. It is located west-northwest of Miami, and is the only place in the county, other than Homestead, Florida, to have its own street grid numbered separately from the rest of the county (which is otherwise based on Miami Avenue at Flagler Street in downtown Miami, the county seat). Hialea...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Staff Credentialing Director jobs
$153,467 to $199,609
Hialeah, Florida area prices
were up 2.9% from a year ago

Medical Staff Credentialing Director in Flagstaff, AZ
In response to this request for providers in ‘good standing’, a file quality letter will be displayed with the Name, Appointment Date, Reappointment Date, Department, Specialty, and Staff Status.
December 09, 2019
Medical Staff Credentialing Director in Portsmouth, OH
Warstler, MBA, CPMSM, FASPR, director, University Hospitals Medical Staff Services and Credentialing; Lisa.
February 07, 2020
Medical Staff Credentialing Director in Altus, OK
In healthcare today, we are all challenged to be more efficient, process credentialing files faster, leverage technology to work smarter, stretch our budgetary dollars, and achieve the highest possible results on accreditation audits and surveys—all while improving the patient experience and providing the highest quality of care.
January 17, 2020