Sr. Director, National Credentialing & Privileging and Medical Staff Offices

Champions and removes barriers to resolve issues during the reviews and requests for primary source information and verifications to focus on long-term strategic needs. Enables relationships for collaboration with external entities. Proactively identifies, suggests improvements to, and provides resolution for complex gaps in vendor relationships. Champions and enables collaborations to disseminate practitioner information during application process. Evaluates applications and supporting highly complex documents. Oversees and provides consultative efforts on complex cases regarding implementation of guidelines and requirements. Oversees alignment of organization-wide priorities and enable relationships to evaluate adverse data. Drives adherence to establish priorities when facilitating efficient cost-effective due process. Evaluates impact, forecasts business needs, enables collaborative relationships, and ensures resources are available for training and regulatory awareness. Determines standards and directs review of enrollment applications. Leads collaborations with internal groups to progress and troubleshoot enrollment status. Removes barriers to and leads development of tools for maintenance of data systems, applications, and controls. Removes barriers and champions implementation of tools for credentialing data analyses. Leads and ensures continued growth in development of guidelines in collaboration with internal leaders for database structures and data use. Regularly collaborates with external/internal leaders. Develops strategies for adherence during development of corrective action plans. Setts expectations for and leads collaborations with others to conduct high-impact audits and site visits.

• Builds organizational capacity and prepares high potentials for growth opportunities and advancement; builds collaborative networks inside and outside the organization for self and others. Provides framework for soliciting and acting on performance feedback; drives collaboration to set goals and provide open feedback and coaching to foster performance improvement. Models and drives continuous learning and oversees the recruitment, selection, and development of talent; stays current with industry trends, benchmarks, and best practices; ensures performance management guidelines and expectations to achieve business needs. Acts as a thought leader on industry trends, benchmarks, and best practices; shares best practices within and across teams to drive improvement. Motivates and empowers teams; maintains a highly skilled and engaged workforce by aligning cross-functional resource plans with business objectives. Provides guidance when difficult decisions need to be made; creates opportunities for expanded scope of decision making and impact across teams.
• Oversees the operation of multiple units and/or departments by identifying member and operational needs; ensures the management of work assignment allocation and completion; translates business strategy into actionable business requirements; ensures products and/or services meet member requirements and expectations while aligning with organizational strategies. Engages strategic, cross-functional business units to champion and drive support for business plans and priorities; assumes responsibility for decision making; sets standards, measures progress, and ensures resolution of escalated issues. Sets and communicates goals and objectives; analyzes resources, costs, and forecasts and incorporates them into business plans; obtains and distributes resources. Anticipates and removes obstacles that impact performance; addresses performance gaps and implements contingency plans accordingly; ensures teams accomplish business objectives; serves as a subject-matter expert and trusted source to executive leadership; provides influence and consultation in the development of the larger organizational or business strategy.
• Leads training and regulatory awareness by: evaluating assessment impact, forecasting business needs, ensuring resources for, and championing strategies to accommodate for future demands of orientation and training for new appointed physician leaders; leading strategy development and removing barriers to enable formation of relationships to efficiently convey informational/educational documents (newsletters, memos) to communicate critical information regarding organizational programs and policies; championing and prioritizing collaborations with interorganizational key stakeholders, both internal and external, to ensure appropriate awareness of key issues and decision-making; ensuring continued growth during leadership meetings aimed at developing on-boarding processes (orientation, training activities) and alignment to education requirements; ensuring organizational implementation of applicable governing documents (bylaws, rules and regulations/policies and procedures) that support and direct organizational practices and ensure compliance; and providing consultation to internal and external parties on the interpretation, interaction, and implementation of current policies, regulations, and legislation and advices on the long term strategies of KP to address the current climate and potential changes which may have long term effects on business operations.
• Ensures quality assurance, improvement, and resolution by: enabling conversations and relationships to remove barriers to the evaluation of practitioner sanctions, complaints, and adverse data to ensure compliance; ensuring long-plan sustainability for teams to conduct ongoing assessments of governing documents (e.g., bylaws/rules and regulations/policies and procedures) to ensure continuous compliance; driving collaborative partnerships across organizations to support surveys and audits of credentialing entities (e.g., CMOs, delegates and health plans for NCQA); establishing and championing organization-wide priorities on efficient and cost-effective due process that complies with internal fair hearing and appeals policies and external legal and regulatory requirements; discussing action plans with facility leadership, holding accountability for responses to, and may report high-impact adverse actions/issues (e.g., sanctions and complaints) taken against a practitioner/provider in accordance with applicable law and contractual requirements; and driving development of state-of-the-art solutions and standards for consistent and accurate review of data between different departments, and monitoring of credentialing and contracting.
• Directs the provider enrollment process by: determining standards for detailed and thorough review of the information used to submit the enrollment applications; prioritizing and enabling organization-wide delivery of timely data and applications to the contracted and government payors in a manner commensurate with their expectations, policies and accreditation standards; and leading collaborations with internal groups to progress and troubleshooting enrollment status to all stakeholders in a clear and timely manner.
• Leads primary source verification and management by: establishing guidelines for the management of the primary source vendor/relationships to ensure accessibility to information and resolve high-impact and complex issues with vendor information; championing long-term strategic development, determining organizational objectives, and outlining timelines for the review process of applications, primary source verifications, and sources provided to identify potential discrepancies and recognize adverse information; overseeing strategic planning and prioritization of and removing barriers to enable the verification and documentation of expirables using acceptable verification sources to ensure compliance with accreditation and regulatory standards; and driving cutting-edge development and implementation of guidelines for processing and enabling relationships for external queries regarding practitioners status.
• Oversees delegation activities by: regularly collaborating with external/internal leaders, developing strategies for adherence during development of corrective action plans, and evaluating wide-spanning gaps or breach of delegated credentialing agreements for potential and existing delegates; establishing standards for the facilitation of mutual agreement and amendments as needed, obtaining of signatures, and maintaining of Delegated Credentialing Agreements; setting expectations for the conducting of and directing pre-assessment, annual site visits, and/or electronic assessments to validate credentialing information; and leading collaborations with State Standardization and Audit teams (e.g., Washington Credentialing Standardization Group Shared Delegation Audit Team, ICE) on shared delegation audits.
• Leads database management by: leading and ensuring continued growth in the development of updated department guidelines in collaboration with internal leaders and KP priorities for the computerized data base of physician data for use in the credentialling and appointment process.
• Applies and ensures control and application of data systems by: driving strategic planning to accommodate for evolving data structures, system functions, creations of workflows, portal management; championing development and implementation of standards for auditing, assessing, procuring, implementing, effectively utilizing, and maintaining practitioner/provider credentialing and delegated processes and information systems (e.g., files, reports, minutes, databases); and establishing guidelines for reviewing, evaluating, establishing vision for improvements to processes (e.g., electronic board memos) to ensure long-term compliance.
• Oversees data management and analyses by: removing barriers to ensure efficient file completion, conduct privileging analyses, and verify privileging to the appropriate specialty/facility, based on data; and leading the development and championing implementation of tools and policies to support knowledge management, record-keeping, and internal and external communication.
• Oversees credentialing and privileging maintenance and management by: overseeing and consulting senior leadership on complex cases for alignment with organization-wide guidelines and requirements for evaluation of application and supporting documents for completeness and to determine applicants initial eligibility for membership/participation; championing and enabling interactions with and information dissemination to practitioner during application process; overseeing and leading the evaluation, presentation, escalation follow-up of complex and intricate practitioner-specific data (e.g., Board Reports, Delegation reports) to decision-making bodies and removing barriers to process improvements, as needed; championing teams to implement and define credentialing and privileging processes for all practitioners/providers; and driving facilitation of internal (e.g., interdisciplinary/scope of practice, medical executives) and providing expert consultative feedback during the facilitation of external committees (e.g., contracted facilities, state), projects, and relevant initiatives to implement change and to move QA initiatives forward.