Posted on July 9th, 2019
Clinical Peer Review opportunity in Vancouver, WA!
PeaceHealth is seeking a talented Clinical Peer Review of Medical Staff Services to coordinate and facilitate the Medical Staff Professional Practice Evaluation process for PeaceHealth’s Columbia Network. In this position, you will work with medical staff leadership to provide accurate clinical summaries, data trends, reports, and analysis for optimal patient safety and quality care. The incumbent is responsible for compliance processes including accreditation/regulatory requirements, legal peer review statues, and Medical Staff Bylaws and policies.
Top reasons to work with PeaceHealth:
- Providing whole person care to Alaska, Oregon and Washington since 1890
- Robust benefits package, including excellent health benefits
- Tuition reimbursement to support continuing education
- Relocation assistance
- Competitive compensation
- Inclusive, Mission-driven company culture
Qualifications for the Independently Licensed BH Clinician Allied Health Professional (AHP) include:
- Associate degree required; bachelors’ degree preferred
- Minimum three (3) years of recent acute care, hospital-based clinical experience; multi-specialty background preferred
- Two (2) years peer review coordination/experience
- Proven clinical acute care case management experience
- Performance improvement or quality experience
- Must be a licensed health care provider: RN, NP, PA, PharmD, MD/DO
To apply or learn more, please visit jobs.peacehealth.org and search Req Id #173737.
PeaceHealth is a not-for-profit health system offering care to communities in Washington, Oregon and Alaska. PeaceHealth has approximately 16,000 caregivers, a medical group practice with more than 1,200 providers, and 10 medical centers serving both urban and rural communities. Visit us online at peacehealth.org to learn more about our mission.
EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state, or federal laws.
Posted on June 20th, 2019
About Clever Care Health Plan:
- Clever Care Health Plan is a new Medicare Advantage insurance company (started in 2019; www.clevercarehealthplan.com). We plan to serve Medicare beneficiaries in Southern California. Our office is located at Little Saigon in Orange County (8990 Westminster Blvd, Westminster, CA 92683). We are passionate in providing best services to our healthcare providers. Our goal is to be the best partner for our providers by creating an easy, reliable and fast credentialing services.
- The Credentialing Specialist is responsible for ensuring that healthcare providers meet federal and state requirements. He/she is responsible for all aspects of the credentialing and re-credentialing processes of professional and institutional health providers. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications. Competitive compensation with health insurance benefit.
Job Functions and Responsibilities:
- This position is responsible to:
- Ensure heath care providers in the health plan’s network are in good standing. All providers meet federal and state requirements to serve Medicare beneficiaries.
- Review credentialing files and work with healthcare providers to obtain missing, incomplete and expiring items.
- Compiles and maintains current and accurate data for all providers.
- Completes provider credentialing and re-credentialing applications; complete primary-source verification; monitors applications and follows-up as needed.
- Completes location credentialing and re-credentialing applications; monitors applications and follows-up as needed.
- Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
- Maintains corporate provider contract files.
- Maintains knowledge of current health plan and agency requirements for credentialing providers.
- Sets up and maintains provider information in online credentialing databases and system.
- Tracks license and certification expirations for all providers to ensure timely renewals.
- Ensures practice addresses are current with health plans, agencies and other entities.
- Maintains information in credentialing database.
- Audits health plan directories for current and accurate provider information.
- Participates and health plan audits
- Establish and maintain long-term working relationships with healthcare providers to ensure customer satisfaction and retention.
- Maintain an accurate and reliable provider database for our members.
- Maintain consistent contact with healthcare providers to ensure that expectations are clear and requirements are completed in a timely manner.
- Utilize advanced problem-solving skills to resolve issues and conflicts that may arise.
- Performs other duties as assigned.
- Associate degree or Highschool diploma.
- 2 years of experience in provider credentialing. Practical-knowledge to use NPDB or Credentialing software.
- Ability to speak in Vietnamese or Chinese Mandarin fluently.
- Well-organized and detail orientated. Professional demeanor. Strong customer service.
- Certified Provider Credentialing Specialist (CPCS) is preferred.
Please email your resume directly to Human.Resources@CleverCareHealthPlan.com
Posted on June 17th, 2019
About City of Hope
City of Hope, an innovative biomedical research, treatment and educational institution with over 6000 employees, is dedicated to the prevention and cure of cancer and other life-threatening diseases and guided by a compassionate, patient-centered philosophy. Founded in 1913 and headquartered in Duarte, California, City of Hope is a remarkable non-profit institution, where compassion and advanced care go hand-in-hand with excellence in clinical and scientific research. City of Hope is a National Cancer Institute designated Comprehensive Cancer Center and a founding member of the National Comprehensive Cancer Network, an alliance of the nation’s leading cancer centers that develops and institutes standards of care for cancer treatment.
This full-time, fast-paced position works in the Medical Staff Services Department (MSSD) to support the credentialing and privileging process and all related activities. In addition, this position is responsible for monitoring the accuracy and timeliness of all credentialing activities performed by other staff members within the Department.
Key Responsibilities include:
Creating and maintaining departmental workflows and process documentation, performing research and analysis to produce SBARs, project management for special projects, training team members and employees in various departments regarding privileging/privilege forms, initiating/sustaining process improvement initiatives in the department using Six Sigma methodology, granting MSOW view-only access to other department within COH as necessary.
• Performs all re-credentialing and re-privileging aspects of Medical Staff and Allied Health Professional Staff using the department’s medical staff software program (MSOW).
• Serves as the subject matter expert to staff members with responsibility to conduct credentialing activities. In addition, monitors and balance the workload of identified staff members to ensure efficiency and productivity in credentialing.
• Creates and maintains credentialing processes and trains and coaches staff on the use of established workflows to ensure accuracy and timeliness.
• Ensures all workflow changes are reflected in departmental policies and procedures and that all changes to processes are in compliance with Medical Staff Bylaws and Rules and Regulations.
• Serves as a liaison between MSSD and IT to ensure that all privilege form changes are implemented and available for use in the e/Delineate privileging software.
• Leads training on the proper use of the department’s medical staff credentialing and privileging software program for new departmental employees, new practitioners to the Medical Center and various departments (e.g. OR schedulers, Departments/Divisions and individual practitioners).
• Other Duties: Responsible for coordinating and overseeing all outgoing credentialing correspondence, including verification of Medical Staff member affiliations; shares responsibility for incoming telephone calls to the MSSD with other department staff; assists in preparing for all accreditation surveys. In addition, supports the Department Director in establishing goals and benchmarks for credentialing team and regularly monitor and report on the progress of those goals.
Basic educational, experience and skills required for consideration:
• Bachelor's degree
• 8 years of work experience as a Credentials/Medical Staff Coordinator and work experience demonstrating computer competency and capability of functioning in the role of a data analyst and/or business analyst
• Experience in acute health care delivery setting with direct knowledge in Joint Commission standards related to credentialing and privileging.
Preferred education experience and skills:
• Two years of college credit, or college courses in Medical Terminology, Business English, Written Composition, Coursework in a quantitative field highly desirable
• Certification from the National Association of Medical Staff Services as a CPMSM (Certified Professional in Medical Services Management) or CPCS (Certified Provider Credentialing Specialist)
• Knowledge of NCQA standards
• Software: Experience in MSOW, e-Delineate, Microsoft Office applications essential. Working knowledge of spreadsheets (Excel), presentation development, word processing, E-mail, and browsers. Knowledge of Crystal Report highly desirable
City of Hope is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, or status as a qualified individual with disability.
Please send resumes directly to Daniel Quinones, City of Hope, Talent Solutions and Operation at email@example.com.
Or you may apply online:
Posted on June 13th, 2019
Job Title: Hospital Credentialing Specialist
Reports to: Manager, Credentialing
FLSA Status: Non-Exempt
Radiology Partners is the largest and fastest growing on-site radiology practice in the US. We are an innovative practice focused on transforming how radiologists provide consistently exceptional services to hospitals, imaging centers, referring physicians and patients. With our state-of-the art clinical technology, specialized expertise, access to capital, and retention of top physician talent, Radiology Partners reliably exceeds the expectations of our clients, patients, and partners. We serve our clients with an operational focus, and, above all, a commitment to quality patient care. Our mission is To Transform Radiology.
The Credentialing Specialist will be coming into the centralized verification office which is comprised of talented business office professionals with significant experience in developing and operating efficiently. The department is a great environment to learn and grow from and reflects the professional, energetic and collaborative culture of Radiology Partners.
Radiology Partners is hiring a Credentialing Specialist. The position will report to a credentialing manager and will be focusing on processing and maintaining provider credentialing information for the entire business.
POSITION DUTIES AND RESPONSIBILITIES
• Compiles and maintains current and accurate data for all providers
• Completes provider credentialing and re-credentialing applications; monitors applications and follows-up as needed.
• Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers
• Maintains knowledge of hospital specific requirements for credentialing providers
• Sets up and maintains provider information in online credentialing databases and systems
• Tracks license and certification expirations for all providers to ensure timely renewals
• Tracks license, DEA and professional liability expirations for appointed providers
• Create and maintain Radiologist credentialing files
• Research and obtain verifications of radiologist credentials
• Coordinate with hospital/center and radiologists to complete credentialing process, including any additional documentation, verifications, references, and applications necessary
• Complete and review all applications to ensure accuracy prior to submission
DESIRED PROFESSIONAL SKILLS AND EXPERIENCE
• Experience in the healthcare industry is a must
• 1 — 2 years of experience in credentialing required
• Ability to organize and prioritize work and manage multiple priorities
• Excellent verbal and written communication skills including letters, memos, and emails
• Excellent attention to detail
• Ability to research and analyze data
• Ability to work independently with minimal supervision
• Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization
• Knowledge and understanding of the credentialing process
• Proficient use of Microsoft Office applications (Word, Excel) and internet resources
Please apply online at https://chu.tbe.taleo.net/chu01/ats/careers/v2/viewRequisition?org=RADIPART&cws=37&rid=1312 or send your resume directly to firstname.lastname@example.org.