Job Summary:

The Credentials Team Lead contributes to the regional credentialing and privileging program that aligns with regional goals, contributes to patient safety, and protects the organization from unnecessary risk of medical malpractice or loss of accreditation or regulatory compliance. Plays a critical role in assisting Kaiser Foundation Health Plan of the Northwest (KFHPNW) in maintaining NCQA accreditation; Kaiser Foundation Hospitals (KFH) in maintaining The Joint Commission accreditation; the Northwest Region in preparing for internal and external surveys, audits, and reviews, and consistently meeting state and federal credentialing requirements. Oversees the day-to-day activities of Credentials staff. Audits all initial credentialing/appointment and recredentialing/reappointment work products to assure compliance with accrediting and regulatory bodies and provides feedback and training in areas where improvement is needed. Oversees the granting of clinical privileges and completion of proctoring for all practitioners who practice in a Kaiser Permanente (KP) hospital and/or ambulatory surgery center.

Essential Responsibilities:

• CLINICAL PRIVILEGES FOR HOSPITALS AND AMBULATORY SURGERY CENTERS: Review and respond to Regional Site of Service Change Management Process to determine impact of new/internalized services/procedures on credentialing and privileging requirements including: identify departments and practitioners involved; research clinical training required to perform new procedures and technical training required for new equipment/technology; assist in developing and gaining approval of new/revised privilege forms and robust proctor plans which may include bringing in specialists from out of state or other KP regions. Meet with each Department Chief and quality leader(s) to complete in-depth review of that departments privilege and proctor forms at least once every three years; revise forms, as needed; present revisions to the Regional Credentials Committee and Medical Executive Committees for approval. Oversee Regional website containing current data on all physicians and practitioners with clinical privileges at a KP Hospital and/or Ambulatory Surgery Center; ensure integrity of data to protect physicians and practitioners from practicing outside their allowed scope of practice.

• SUBJECT MATTER EXPERT: Collaborate with other KP regions by participating in the Credentialing and Privileging Community Practice Group to design, deploy and implement credentialing program approaches that result in efficiency, improved processes or systems, and innovation to support changing care delivery plans and contracts. Participate in training/orientation for Clinical Department Chiefs, KFH/HP leaders, and care delivery managers, as needed. Contributes expert guidance and consultation to department chiefs and hospital leadership for TJC Medical Staff Standards. Assist KP legal counsel and defense attorneys with legal cases or fair hearing proceedings. Serve as member of the KPNW Regional Credentials Committee. Serve on State or Community advisory committees and professional boards. Stay abreast of new and pending OR and WA legislation and regulatory and accreditation standard changes related to credentialing and clinical privileges. Maintain a thorough knowledge of and ability to interpret accreditation standards and regulatory requirements and internal (KFH/HP) standards related to credentialing and clinical privileges. Maintain a thorough knowledge of Professional Staff Bylaws, Rules, and Regulations for KFH hospitals and ambulatory surgery centers in the Northwest region. Exhibits a high degree of responsibility for confidential matters.

• REGIONAL CREDENTIALING AND PRIVILEGING PROGRAM: Oversees the processing of all Medical Staff and Allied Health Staff appointments and reappointments in accordance with Medical Staff Bylaws, Rules and Regulations, The Joint Commission Medical Staff standards, and State and Federal law. Participates in preparations for accrediting and regulatory audits and surveys; participates in credentialing interviews related to credentialing and privileging activities. Plays critical role in annual KFH/KFHP Boards of Directors Quality Oversight audit. Timeliness and high degree of accuracy required to oversee monthly Credentials Committee reports to the Medical Executive Committees of each hospital and ambulatory surgery center, and ultimately to the KFH and KFHP Boards of Directors for final approvals. Participate in development and revision of KPNW Regional Credentialing & Recredentialing Policies & Procedures to ensure compliance with accrediting bodies and regulatory requirements. Develop, revise and maintain current desk procedures for credentials functions a so that essential business functions can continue without interruption in process or quality. Audit 100% of all initial appointment files, reappointment files, and requests for privileges to assure accuracy and timeliness and to maintain credentials and quality files survey ready.

• TEAM LEAD ACCOUNTABILITIES: Oversee Credentials staff and provide input on hiring decisions and performance evaluations. Identify opportunities to replace manual processes, reduce variation, and promote data integrity. Proactively identify issues, coordinate issue resolution, and monitor events to determine educational opportunities for training and development of Credentials staff members. Enhance staff performance by assisting/supporting Credentials Specialists to meet/exceed required accuracy rates. Develop training methods and materials.

  Basic Qualifications:

  Experience

• Minimum five (5) years of experience in credentialing and priveleging in one of the following venues: hospital, managed care, credentialing verification organizations, or ambulatory care.

• Minimum two (2) years of team lead/coordination experience.

• Minimum two (2) years of experience in medical staff services.

• Experience working with governance processes.

• Experience with The Joint Commission, NCQA, and CMS standards related to Medical Staff and Credentialing.

  Education

• Bachelors degree OR four (4) years of experience in a directly related field.

• High School Diploma or General Education Development (GED) required.

  License, Certification, Registration

• Professional Medical Services Management Certificate within 12 months of hire OR Provider Credentialing Specialist Certificate within 12 months of hire

  Additional Requirements:

• Ability to understand highly complex, heavily regulated processes in dynamic healthcare market while maintaining highest level of data integrity, confidentiality, and protection.

• Working knowledge of peer review fair hearing practices, mandatory reporting of adverse actions.

• Demonstrated excellent analytical and problem-solving skills including ability to perform audits, write reports, and resolve sensitive confidential issues.

• Strong computer, communication and writing skills with knowledge of medical terminology.

  Preferred Qualifications:

• Minimum seven (7) years of experience in one of the following venues: hospital, managed care, credentialing verification organizations, or ambulatory care.

COMPANY: KAISER

TITLE: Team Lead, Credentials

LOCATION: Portland, Oregon

REQNUMBER: 1293032

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, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.