Senior Credentialing Specialist - Medical Staff Admin - F/T Days - University of California, Irvine

Position Summary:

The University of California, Irvine, a career destination unlike any other, is built upon a rich history of academic and healthcare excellence. We are supported by a globally unique team of academic professionals, researchers, medical experts, and staff. Guided by our mission, vision, and strategic pillars, we thrive in a collaborative environment. We celebrate and leverage the diverse experiences and perspectives of our UCI community to continue to push the boundaries of innovation. Your opportunity to be a part of an award winning team, advancing your career journey, is now!

Incumbent is an advanced technical professional who functions with minimal supervision applying extensive knowledge and expertise in the field to problem solve, formulate strategies in unique and complex situations, and administer policies, processes, and resources. The Senior Credentialing Specialist serves as an essential link and resource between department senior management and the medical staff to coordinate the operational processes and ongoing credentialing, privileging, and medical staff governance functions of the Medical Staff Administration Department. Responsible for review, analysis and follow up, and processing credentialing and privileging applications and ensuring compliance with organizational policies and accrediting and regulatory standards. Responsible for meeting management to the Credentials Committee. Acts as mentor to other credentialing specialists, and provides other support and assistance within the department as needed or assigned.

Essential Job Functions:

The identification of essential functions below is not intended to be an exhaustive list of all duties that may be assigned to this position, nor does it restrict the duties which may be assigned to this position if such duties reasonably relate to the position.

• Works with clinical department chairs to develop and revise clinical privilege criteria. 10%
• Supervision: Assists in the evaluation of staff performance within the unit, functions as role model, oversees daily review and spot-check of work, verifying accuracy and completeness, provides effective training to staff as needed, serves as a resource person to resolve problems as they occur in the work unit, and oversees daily review and spot-check of work, verifying accuracy and completeness. 25%
• Responsible for all aspects of the credentialing, recredentialing, and privileging processes for assigned practitioners who provide patient care at UC Irvine Health. Responsible for ensuring practitioners are credentialed, appointed, and privileged to work at UC Irvine Medical Center and ambulatory sites on the hospital license. Verifies education, training, clinical experience, peer references, current licensure and certification, and malpractice history through primary sources to complete credentialing and recredentialing applications. Ensures that credentials meet criteria set forth in the Medical Staff Bylaws as well as accrediting standards and regulations. 35%
• Responsible for all aspects of the credentialing, re-credentialing and privileging processes for assigned medical practitioners who provide patient care at UC Irvine Health. Responsible for ensuring practitioners are credentialed, appointed, and privileged to work at UC Irvine Medical Center and ambulatory sites on the hospital license. Ensures that credentials meet criteria set forth in the Medical Staff Bylaws as well as accrediting agency standards. Maintains up-to-date data for each practitioner in credentialing databases and online systems; ensure timely notification of renewal of licenses and certifications in assigned areas of responsibility. Reviews applications, prepares verification letters and maintains database. Verifies education, training, peer references, current licensure, and malpractice history through primary sources to complete credentialing and recredentialing applications. Establishes and maintains effective filing systems. 25%
• Represents department, participates on and supports assigned committees and projects. Serves as the department representative for the Credentialing Committee including presenting credentialing files, and providing effective resolution and follow up to identified issues. Provides department general administrative support as needed or assigned. 25%
• Provides meeting management to the Credentials Committee, including scheduling meetings, preparing agendas, taking, and transcribing meeting minutes, performing meeting follow up, and preparing and maintaining committee action reports. 10%
• Provides meeting management to the Credentials Committee, including scheduling meetings, preparing agendas, taking, and transcribing meeting minutes, performing meeting follow up, and preparing and maintaining committee action reports. Provides other support and assistance within the department as needed or assigned. 10%
• Provides customer service support to clinical department chairs, chief administrative officers, and practitioners in interpreting medical staff bylaws, rules and regulations, policies, and procedures. 20%
• Maintains up-to-date data for each practitioner in credentialing database and online systems. Establishes and maintains effective electronic filing systems. 15%
• Administers the development, implementation and monitoring of credentialing procedures required by the Medical Staff Bylaws, state and federal laws, hospital accreditation and NCQA standards. Acts on behalf of the Medical Staff Administration Director as appropriate. Oversees daily review and spot-check of work, verifying accuracy and completeness. Provides direction for personnel, prioritizing and facilitating workflow to ensure efficient delivery of service. Serves as a resource and mentor to credentialing specialist. 25%
• Acts as a mentor to the other credentialing specialists, including assisting in training of new staff, serving as a resource in interpretating medical staff bylaws, rules and regulations, policies and procedures, and auditing of completed credentials files to ensure compliance with credentialing policies and procedures and accrediting standards and regulations. 10%

Total Compensation

We offer a wealth of benefits to make working at UCI even more rewarding. These benefits may include medical insurance, sick and vacation time, retirement savings plans, and access to a number of discounts and perks. Please utilize the links listed here to learn more about our compensation practices and benefits.

Required Qualifications:

• Working knowledge of MS Office products
• Working knowledge and experience with MS Office Suite (Outlook, Word, Excel, PowerPoint, SharePoint)
• Strong verbal and written communication skills
• Strong analytical and problem solving skills and the ability to plan strategically
• Strong Knowledge of Joint Commission JCAHO, NCQA, and Title 22 regulations
• Must possess the skill, knowledge and ability essential to the successful performance of assigned duties
• Must possess the skill, knowledge and abilities essential to the successful performance of assigned duties
• Must demonstrate customer service skills appropriate to the job
• Minimum of five (5) years in the overall field with expertise in specific areas, including credentialing, privileging, formulating strategies, and administering policies and processes
• Minimum of five (5) years credentialing and privileging experience for medical practitioners
• Minimum of 5 years experience in credentialing medical staff
• Knowledge of medical staff credentialing and privileging processes and procedures
• Knowledge of FPPE/proctoring processes and procedures
• Excellent written and verbal communication skills in English
• Excellent verbal and written English communication skills
• Discretion and judgment in the handling of confidential and/or sensitive information
• Demonstrated understanding of medical terminology
• Demonstrated skill and ability to independently set and meet deadlines, multi-task, and effectively manage competing priorities
• Demonstrated advanced skill and proficiency in MS Office Suite (Outlook, Word, Excel, PowerPoint, SharePoint)
• Demonstrated advanced knowledge in data analysis, research and reporting, particularly with respect to licensure compliance
• Demonstrated ability to multi-task and manage time and prioritize projects efficiently and effectively
• Demonstrated ability to apply sound judgment and formulate strategies in ambiguous situations and effectively manage change
• Demonstrated ability to apply knowledge and recommend viable solutions for complex situations
• Current NAMSS certification as CPCS and/or CPMSM
• CPCS and/or CPMSM Certified
• Bachelor's degree in related area and / or equivalent experience / training
• Advanced knowledge of Joint Commission, CMS Conditions of Participations, and NCQA and Title 22 accreditation standards and regulations
• Advanced knowledge and expertise in medical staff credentialing and privileging processes and procedures
• Advanced analytical, critical thinking, organizational, and project management skills
• Ability to persuade or influence people to take appropriate action
• Ability to multi-task, prioritize projects, and manage time efficiently and effectively
• Ability to maintain professional demeanor and poise while working under pressure, meeting deadlines, and managing changing priorities
• Ability to maintain a work pace appropriate to the workload
• Ability to establish and maintain effective working relationships across the Health System
• Ability to coordinate and resolve issues in a timely manner
• Ability to complete job responsibilities with a high degree of accuracy under minimum supervision
• Ability to apply sound judgment in ambiguous situations and effectively manage change

Preferred Qualifications:

• Minimum of two (2) years meeting management experience
• Knowledge of university and medical center organizations, policies, procedures, and forms
• Knowledge of University policies and procedures
• Experience with MD-Staff Credentialing Database Software
• Dual NAMSS certification as CPMSM and CPCS
• Dual Certification in any of the following areas: CPMSM, CPCS, CPHQ
• Bachelor's degree

Conditions of Employment:

The University of California, Irvine (UCI) seeks to provide a safe and healthy environment for the entire UCI community. As part of this commitment, all applicants who accept an offer of employment must comply with the following conditions of employment:

• Background Check and Live Scan
• Legal Right to Work in the United States
• Vaccination Policies
• Smoking and Tobacco Policy
• Drug Free Environment

The following additional conditions may apply, some of which are dependent upon business unit or job specific requirements.

• California Child Abuse and Neglect Reporting Act
• E-Verify
• Pre-Placement Health Evaluation

Details of each policy may be reviewed by visiting the following page: https://hr.uci.edu/new-hire/conditions-of-employment.php

Closing Statement:

The University of California, Irvine is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected categories covered by the UC nondiscrimination policy.

We are committed to attracting and retaining a diverse workforce along with honoring unique experiences, perspectives, and identities. Together, our community strives to create and maintain working and learning environments that are inclusive, equitable, and welcoming.

UCI provides reasonable accommodations for applicants with disabilities upon request. For more information, please contact UCI's Employee Experience Center (EEC) at eec@uci.edu or at (949) 824-0500, Monday - Friday from 8:30 a.m. - 5:00 p.m.