Attachment_1_Position_Description.pdf

Attachment 1

Credentials Manager (CM)

SUMMARY: to design, implement, direct and analyze the credentials program to ensure the medical and dental staff have qualified and competent healthcare professionals IAW Department of Defense DoD, Defense Health Agency (DHA), Air Force Medical Operations (AFMOA), and The Joint commission (TJC) guidance and policies. The CM provides expert knowledge to the Medical Group Commander

(MDG/CC), Chief of the Medical Staff (SGH), MDG staff. The CM will initiate, maintain and analyze credentials and privileging files on each privileged healthcare provider on staff or seeking to obtain privileges.

QUALIFICATIONS:

1.1. Mandatory Knowledge and Skills:

1.1.1. Practical knowledge and understanding of established credentialing standards from TJC, the Air

Force and the DoD or demonstrated ability to quickly grasp and apply similar concepts.

1.1.2. Practical knowledge and experience in database management.

1.1.3. Skilled in typing and file management.

1.1.4. Proficient in developing power point presentations.

1.1.5. Proficient written and oral communication skills to provide briefings to leadership, training to staff and communicate with internal and external customers as relates to the credentialing process, clearly expressing information taking into account the audience and nature of the information.

1.1.6. Proficient in understanding, interpreting and applying written guidance and policies to include technical material such as graphs, tables and charts.

1.1.7. Basic knowledge of medical terminology, nomenclature and procedures relevant to the credentialing process.

1.1.8. Practical knowledge of medical specialties and ancillary services.

1.1.9. Broad knowledge of individual state medical board, national medical certifying boards and other agency requirements regarding licensing and certification.

1.2. Education/Certification:

1.2.1. A minimum of an associate’s degree from a recognized accredited organization or life experience equivalent as determined by the medical group executive staff.

1.3. Experience: Prior experience in credentialing preferred however not mandatory.

1.4. Work environment/Physical requirements: The work is primarily sedentary. Requirements may include prolonged walking, standing, sitting or bending. Carrying or lifting of medical records or documentation may be required daily. May require travel once or twice a year to the continuous continental United States for conferences.

2. Unique Military Health Care Systems/Procedures:

2.1. Composite Health Care System (CHCS)

2.2. Armed Forces Health Longitudinal Technology Application (AHLTA): electronic health record

2.3. MHS Genesis: electronic health record

3. Performance Outcomes:

3.1. Responsible for managing the credentials program IAW Air Force Instruction 44-119 Medical Quality

Operations, AFMOA, DoD and TJC guidance/policies.

3.1.1. Receives, establishes and maintains provider credential folders (PCF) IAW Air Force, AFMOA, DoD and TJC guidance. Provides guidance to providers during the initial and renewal privileging process.

3.1.2. Conducts necessary research of background data to document provider skills to support competency in the requested medical privileges and appropriately credential providers within his/her specialty. Primary source verifies medical, dental and allied healthcare professional credentials documents and information.

3.1.2.1. Conscientiously and independently exercises the authority to reject and/or return unsatisfactory submissions for clinical privileges and determines if any resulting delays warrant the interruption of workflow to perform the missing verifications locally.

3.1.3. Briefs newly assigned providers on credentialing procedures and required forms. Provides status changes to Chief of Medical Staff based on known and received data into the PCF. Presents initially privileged provider credentials for review and reappointment for privileges.

3.1.4. Prepares agenda for credential function meeting, ensures all necessary materials are present for committee member’s review. Records, prepares and distributes minutes in a timely manner. Prepares notification letters to providers regarding committee actions.

3.1.5. Establishes, maintains, controls and updates credentials file system to enable quick and efficient retrieval of information.

3.1.6. Manages the privileged provider peer review process. Tracks completion, monitors for trends, maintains reviews in provider files and updates Chief of the Medical Staff. Briefs peer review status as needed to appropriate committees.

3.1.7. Tracks completion of focused and on-going professional practice evaluations for medical staff appointments/privileging processes.

3.1.8. Routinely collaborates with the process improvement manager and risk manager to assist in collecting on-going performance based provider data as part of the re-privileging process.

3.1.9. Serves as point of contact for fee-exempt Drug Enforcement Agency (DEA) registration and

National Provider Identification Type 1 registration.

3.1.10. Serves as the Medical Treatment Facility (MTF) Centralized Credentials and Quality Assurance

System (CCQAS) Database Administrator, authorizing new user status and training individuals as required.

3.1.10.1. Establishes and maintains CCQAS electronic records, ensuring database is current.

3.1.11. Assists the Chief of Medical Staff with adverse action documentation and procedures.

3.1.12. Coordinates with Risk and Quality Managers in the initiation, tracking and completion of

Standard/Quality of Care Reviews.

3.2. Provides administrative support to the Chief of Medical Staff as it relates to the required Prostaff, Executive Committee of the Medical Staff, and credentials function meetings.

3.2.1. Accurately prepares for Prostaff, and Executive Committee of the Medical Staff meetings.

Prepares meeting minutes for the aforementioned meetings.

3.2.2. Assists Chief of the Medical Staff in development and execution of continuing medical education activities for the medical staff.

3.2.3. May support administrative duties in other Chief of Medical Staff functional areas if does not interfere with primary credentialing duties.