Manager, Credentialing - Medical Staff Services

NYU Langone Health is a fully integrated health system that consistently achieves the best patient outcomes through a rigorous focus on quality that has resulted in some of the lowest mortality rates in the nation. Vizient Inc. has ranked NYU Langone the No. 1 comprehensive academic medical center in the country for three years in a row, and U.S. News & World Report recently placed nine of its clinical specialties among the top five in the nation. NYU Langone offers a comprehensive range of medical services with one high standard of care across 6 inpatient locations, its Perlmutter Cancer Center, and over 320 outpatient locations in the New York area and Florida. With $14.2 billion in revenue this year, the system also includes two tuition-free medical schools, in Manhattan and on Long Island, and a vast research enterprise with over $1 billion in active awards from the National Institutes of Health.

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Position Summary:
We have an exciting opportunity to join our team as a Manager, Credentialing - Medical Staff Services.

In this role, the successful candidate The MSS Manager for quality and audit is responsible for audit of files for monthly credentials committee and ongoing file reviews before delegated audits, regulatory audits and surveys and OPMC and other file requests. This position audits the credentialing verification process on physicians/dentists and allied health practitioners in accordance with regulatory and accreditation requirements. This position manages the regulatory compliance function of the Medical Staff Services offices to assure departmental achievement of compliant documentation with multiple requirements including monthly sanction screens, monitoring of OIG, Opt-Outs, exclusions, expireables, etc. and advisory alerts from OPMC. This position also manages the provider regulatory training requirements and required learning to assure departmental achievement of compliant documentation with multiple physician requirements.

Job Responsibilities:

1. Maintains knowledge of standards of the Joint Commission on Accreditation of Healthcare Organizations, National Committee for Quality Assurance and State and Federal regulations related to Medical Staff organization.
2. Maintains working knowledge of the Medical Staff Bylaws, Rules and Regulations, and Hospital policies, and works to ensure the medical staffs compliance within the stated parameters.
3. Prepares for regulatory survey for the medical staff/leadership function, including staff and medical staff education regarding accreditation standards.
4. Participates in onsite surveys by TJC, CMS, NYS DOH, NCQA or other agencies as needed.
5. Closely monitors information collected by the teams to assure it meets Joint Commission, DOH and other regulatory requirements, evaluates information collected for adequacy and completion, and pursues additional information as necessary. Ensures that quality assurance standards are upheld and conducts continuous audits as a means of oversight.
6. Responsibility and accountability for auditing the application process for the appointment and clinical privileging of physicians and other health care practitioners.
7. Conducts audits of the sProvider database to assess completeness of information and qualifications relative to established standards, accuracy of data entry and updated information in files.
8. Manages regulatory training assignments in LMS for all new appointments to the Medical and Dental Staff including orientation and annual education programs. This includes providing individual assistance to practitioners to access required courses in LMS.
9. Responsible for conducting Information Integrity Training for all credentialing staff members on an annual basis to ensure compliance with NCQA standards for delegated credentialing.
10. Responsible for conducting the annual audit of provider files credentialed and re-credentialed during the previous year to ensure compliance with NCQA standards for delegated credentialing.
11. Participates in other Medical Staff functions and projects as necessary.
12. Assists in setting up office systems for credentialing related matters.
13. Performs other duties as directed and leadership activities, as assigned.

Minimum Qualifications:
To qualify you must have a Bachelor's Degree and NAMSS certification plus a minimum of five years of progressive responsible experience in an administrative role, or an equivalent combination of education and experience. Experience with credentialing management system (i.e. sProvider, CAQH, etc.). Excellent verbal and written communication skills. Self-motivated with the ability to complete projects independently within established timeframes. Ability to handle multiple projects and deadlines. Must be well organized and able to prioritize responsibilities.

Preferred Qualifications:
Master's Degree. Working knowledge of Provider credentialing database. Able to demonstrate good independent judgment and strong interpersonal relationship skills in working with direct employees, medical staff leaders and other Departments in the NYU Health system.

Qualified candidates must be able to effectively communicate with all levels of the organization.

NYU Langone Health provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you'll feel good about devoting your time and your talents.

At NYU Langone Health, we are committed to supporting our workforce and their loved ones with a comprehensive benefits and wellness package. Our offerings provide a robust support system for any stage of life, whether it's developing your career, starting a family, or saving for retirement. The support employees receive goes beyond a standard benefit offering, where employees have access to financial security benefits, a generous time-off program and employee resources groups for peer support. Additionally, all employees have access to our holistic employee wellness program, which focuses on seven key areas of well-being: physical, mental, nutritional, sleep, social, financial, and preventive care. The benefits and wellness package is designed to allow you to focus on what truly matters. Join us and experience the extensive resources and services designed to enhance your overall quality of life for you and your family.

NYU Langone Health is an equal opportunity employer and committed to inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration. We require applications to be completed online.

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NYU Langone Health provides a salary range to comply with the New York state Law on Salary Transparency in Job Advertisements. The salary range for the role is $81,325.15 - $110,493.20. Annually. Actual salaries depend on a variety of factors, including experience, specialty, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.

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