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Kaiser Permanente Careers

Quality Assurance, UR & Case Management

Passion + Vision + Integrity = Excellence

Ensure consistency and the highest ethical standards across our entire organization. Our quality assurance team drives ongoing improvement by fostering an environment of support, providing technical and specialized consultative services, and inspiring ongoing excellence.

Medical Staff Services Specialist

Location: Wailuku, HI Job Number: 919685 Date posted: 11/20/2020

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Description:
Under the direction of the Director of Medical Staff Services, coordinates internal and external activities of the Medical Staff including, but not limited to credentialing and privileging, medical staff meeting management, facilitating Focused Professional Practice Evaluations (proctoring) for initial and new clinical privilege requests.  This position assists the Medical Staff Organization, Medical Staff Services Department & Medical Staff Committees in pursuit of their responsibilities as defined in the Medical Staff Bylaws, Rules & Regulations, Allied Health Professionals, and Organizational Manual of the Medical Staff.

Essential Responsibilities:
  • Process credentialing, recredentialing and clinical privilege applications for health care provider applicants.
  • Conducts thorough background investigation, research and primary source verification of all components of the applications and ensures files are current and noted in detail in the system of record.
  • Set-up and maintain provider information in an online credentialing database system.
  • Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow-up.
  • Achieves productivity standards as determined by management.
  • Tracks all expirable documents, including but not limited to license & certification for all providers to ensure timely renewals.
  • Manages the functions required to comply with internal & external policies & procedures, accreditation standards, laws and CMS COPs, and any other applicable bodies.
  • Coordinates Medical Staff Services and Committee meetings in all aspects, which includes but not limited to facilitating meeting arrangements, preparing agendas, taking and preparing minutes, and facilitating / performing follow-up actions necessary.
  • Utilizes credentialing data base or other software to create and maintain efficient systems for filing; prepare reports and special projects.
  • Develops/prepares reports for meetings, including the credentials report for presentation to the Credentials Committee, Medical Executive Committee and Board of Directors in a professional format.
  • Prepares applications for membership / clinical privileges for review by Divisions, Departments and Credentials Committee.
  • Ensures that all applications are reviewed and signed/dated as required.
  • Maintains efficient logs and tickler systems to prompt timely processing of all applications for privileges and membership.
  • Communicates findings of any suspected or noted adverse or unfavorable information to Director and medical staff leadership prior to being reviewed and forwarded for review & recommendation.
  • Prepares and disseminates correspondence to applicants notifying them of board actions.
  • Coordinates room reservations, setup including catering and audiovisual equipment as requested as assigned.
  • Maintains accuracy and integrity of credential files, electronic files and appropriate databases.
  • Performs general office functions (receives & welcomes guests, answering phone, providing office coverage, ordering/tracking supplies, correspondence and other tasks as assigned.
  • Mail pickup, deliver, and sort daily.
  • Provides assistance and administrative support to Director and medical staff leaders as needed.
  • Assists medical staff as needed.
  • Basic Qualifications:
    Experience
  • Minimum three (3) years of experience in a healthcare related field. 
  • Education
  • Associates degree or two (2) years of experience in a directly related field.
  • High School Diploma or General Education Development (GED) required.
  • License, Certification, Registration
  • Certification by the National Association of Medical Staff Services (NAMSS) as a Certified Provider Credentialing Specialist (CPCS) / Certified Professional Medical Services Management (CPMSM) within 3 years of hire date. 

  • Additional Requirements:
  • Knowledge of federal and state regulatory requirements and accreditation standards (TJC, DHS, CMS, and Title 11 (HI)
  • Data base management skills including querying, reporting, and document generation.
  • Proficiency with Medical Terminology
  • Excellent oral, written, and interpersonal skills
  • Strong organizational, analytical and problem-solving skills
  • Ability to function independently with minimal direct supervision
  • Office experience within a hospital setting
  • Ability to spell, punctuate and file accurately. Demonstrated minute taking skills.
  • Demonstrated abilities to professionally handle public contact, highly confidential and sensitive information and maintain effective work flow systems.
  • Abilityto type 50 WPM
  • Proficiency with MS Office
  • Ability to adapt to changing schedules, deadline and demands
  • Exceptional Customer Service Skills

  • Preferred Qualifications:
  • Minimum one (1) year of experience directly related to Medical Staff Services in a hospital or managed care credentialing setting.
  • Bachelor's degree preferred.
  • Primary Location: Hawaii,Wailuku,Memorial - Cottage Buildings 285 Mahalani St. Additional Locations: Wailuku Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 8:00 AM Working Hours End: 4:30 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Non-Union, Non-Exempt Job Level: Individual Contributor Job Category: QA / UR / Case Management Department: Hosp Admin-Med Staff Office Travel: No Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

    External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.

    Learn About QA, Ur & Case Management Careers

    Careers In QA, Ur & Case Management

    As an organization, we are committed to delivering the same exemplary care no matter who you are, where you are, or what your needs. But how are those standards defined, measured, and assessed? That's where our quality assurance team comes in. Implementing the action plans and initiatives that will drive successful practices, you'll work across the organization to foster the necessary education, communication, and innovation that will enable us to operate as one KP — with our mission and goals in complete alignment.

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