Director, Credentialing

Kaiser Permanente   •  

Oakland, CA

Industry: Healthcare

  •  

8 - 10 years

Posted 19 days ago

Description:
Manages projects and programs to achieve an effective and reliable infrastructure to meet the goals and objectives of hospital and health plan quality oversight. Accountable for managing all phases of improvement projects including design, prioritization, staffing, development, implementation, analysis, metrics, and reporting. Prepares reports on appropriate oversight areas including patterns, trends, and organizational risk. Coordinates and delivers education, training, and communication programs. Develops program-wide templates for appropriate policies and procedures, and ensures implementation for consistent programs and infrastructures across the enterprise. Functions as an expert authority to all entities in regions. At the highest level of the job family, shares in accountability of outcomes and performance for all regions and the enterprise in oversight areas.


Essential Responsibilities:

  • Supports the Senior Director and Executive Director in management of the business unit and performs some of the duties in his/her absence. Develops and establishes within the area managed the strategic direction and plan. Implements the strategic plan. Assists the KFHP/H Board of Directors' (QHIC) fiduciary responsibility for performing quality oversight as a governing body. Assists the KPNQC in providing program-wide quality management on behalf of QHIC and the Permanente Executive Committee.


  • Establishes and assures adherence to whole system structures, processes, accountabilities, and roles to ensure adequate health plan/ hospital oversight. Manages teams to perform periodic assessment to ensure adequate oversight of health plan/ hospital activities. Evaluates and makes recommendations for systematic processes to ensure resolution of gaps.

  • Oversees implementation of initiatives and corrective action plans for issues identified by KPNQC, QHIC, or other appropriate sources. Applies knowledge of trends and patterns to decrease and remediate health plan/ hospital risk. Establishes and assures adherence to monitoring processes to ensure ongoing compliance with actions implemented. Provides routine updates for sponsors and other stakeholders. Facilitates resolution of issues and barriers related to project systems. Communicates with and supports national and regional efforts in these content areas at all levels of the enterprise.

  • Designs complex projects involving stakeholders and obtains agreement on project design, implementation and evaluation methodologies. Analyzes a broad array of quantitative and qualitative issues across disciplines, projects and functional areas. Partners with the national Compliance Office to coordinate those quality activities that overlap between quality and compliance. Establishes effective working relationships with peers both internal and external to KP. Develops and establishes oversight for strategically important health plan/ hospital accreditation surveys NCQA, TJC.


Basic Qualifications:
Experience

  • Minimum three (3) years of management experience.

  • Minimum eight (8) years of related experience.


Education

  • Bachelor's degree in related field, OR four (4) years of directly related experiencerequired.

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


License, Certification, Registration

  • Certified Provider Credentialing Specialist (CPCS), or obtained within 12 months of hire.

  • Certified Professional Medical Services Management (CPMSM), or obtained within 12 months of hire.




Additional Requirements:

  • Requires advanced knowledge of own area of functional responsibility and working knowledge of multiple related functions.

  • Advanced knowledge and broad expertise of policies, practices, and systems.

  • In depth knowledge with demonstrated success in change management and implementation of programs across disciplines and geographical locations.

  • Must be able to work in a Labor/Management Partnership environment.




Preferred Qualifications:

  • Five (5) years directly related credentialing experiencepreferred.



  • Master's degree in a directly related field preferred.

730164