Professional Staff Services Manager

Gateways Hospital

and Mental Health Center

Job Description

Title of Position: Professional Staff Services Manager

Location: Gateways Hospital and Mental Health Center

Exempt/Non-Exempt: Exempt

Union/ Non-Union: Non-Union

Supervisor: Director of Quality Improvement

Summary Of Position

The Professional Staff Services Manager is responsible for credentialing and re-credentialing, managing the Ongoing Professional Practice Evaluations (OPPE), Peer Reviews, and other compliance needs for all healthcare providers on the hospital’s Professional Staff list.

This position ensures all providers on the Professional Staff are appropriately credentialed, which includes the responsibility of maintaining current and accurate information on file and within the credentialing database. This position also includes managing the Medical Executive Committee & Peer Review Committee with the preparation of agendas, timely documentation of minutes and all associated follow-ups. The Professional Staff Services Manager supports the Quality Improvement Department by submitting Key Performance Indicators to the Quality Improvement Committees. This position works primarily independently, but frequently coordinates with other team members, the Medical Director, the CEO and Human Resources and reports to the Director of Quality.

Essentials Duties

• Timely and accurate completion and follow-up of all Professional Staff members credentialing and re-credentialing applications, including requests for clinical privileges.
• Monitors, manages all credentialing and re-credentialing requirements, and ensures the collection of all required renewal certifications are scanned and on file within the required timeframe.
• Data entry and tracking of new applications in the credentialing database.
• Maintains the credentialing database and ensures up-to-date information is always obtained.
• Maintains a working knowledge of the required HFAP standards, State and Federal regulations related to credentialing and Professional Staff requirements.
• Performs and collects primary source verification (PSV) documentation for licensing, board certifications, proof of professional liability insurance, National Practitioner Data Bank (NPDB) and/or other sources as required based on HFAP standards and Gateways Hospital and Mental Health Center’s policies and procedures.
• Prepares credentialing reports, including any adverse action documentation.
• Assists with the creation and revision of Professional Staff policies and procedures as needed.
• Assists the Medical Director with the Medical Executive Committee (MEC) meetings, prepares agendas, provides the necessary documentation support and timely follow-up with all new and unfinished business.
• Provides support to professional staff, professional staff office staff with any questions related to the application and re-application process.
• Processes provider demographic changes ensuring appropriate documentation has been submitted with the changes, updates the credentialing database and notifies appropriate staff, as necessary, of the changes.
• Processes provider specialty/category changes and leave of absence requests.
• Performs timely audits of California data bases related to disciplinary reports, OIG reports, and other reports as required and initiates the formal complaint procedure when applicable.
• Assists during the accreditation survey process as requested related to professional staff data and information.
• Manages the FPPE/proctoring process for monitoring all initially appointed providers in a timely manner.
• Participates with the Quality Department in facilitating OPPE/FPPE data outcomes into the ongoing professional staff practice monitoring and re-credentialing process.
• Manages the E.H.R’s Identity Verification, EPSC Provider Set up & Trusted Agent Responsibilities.
• Cross trains within the Quality Department to support credentialing operations for all Professional Staff related duties in the event of vacation, leaves or absences.
• Manages the Network Adequacy Data in the Network Adequacy Provider and Practitioner Administration (NAPPA).
• Attends DMH Network Adequacy (NAPPA) meetings.
• Manages all Professional Staff’s NPI through the NPPES NPI Registry Portal
• Oversees all license expirations (professional and nonprofessional staff (i.e. LCSW) in conjunction with Human Resources.
• Participates in education/training as required.
• Complies with all HIPAA and Compliance policies and procedures and other applicable hospital and/or department policies and procedures.
• Performs other duties as assigned by hospital management.
• Maintains privacy at all times.
  
  

Experience/Qualifications

• Minimum of 1 year credentialing experience required.
• Working knowledge of credentialing accreditation regulations and policies and procedures required.
• Computer skills with knowledge of medical staff software or similar applications required.
  
  

EDUCATION & CERTIFICATES

• Bachelor’s degree or associate degree preferred. High School Degree required.
• Certified Professional Medical Services Management certification (CPMSM) preferred and required within 1 year of hire.
• Certified Professional Credentialing Specialist (CPCS) certification required within 1 year of hire.
  
  

Requirements

• Must pass Department of Justice (DOJ), Federal Bureau of Investigations (FBI), and Community Care Licensing (CCL) background clearance.
• Valid California Driver’s license.
• TB clearance.
• Driving record acceptable for coverage by Gateways insurance carrier.
• Fire and Safety Training*.
• Crisis Prevention Institute Training (CPI)**
• Note: If indicated certifications/licenses are lacking, they must be obtained within 180 days of hire.
• Training needs to be completed within 30 days from the date of hire on a designated date provided by on-boarding. Staff need to be certified at the commensurate level for their role to perform their job duties (staff will be taken off the schedule if certification is not achieved).
  
  

Physical Requirements

• To perform this job you must be able to carry out all essential functions successfully. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the job.
• Employee will be required to lift and/or move unassisted up to 25 pounds.
  
  

Job descriptions are not intended, and should not be construed, to be exhaustive lists of all responsibilities, skills, efforts or working conditions associated with a job. They are meant to be accurate reflections of the principal job elements.

This description in no way states or implies that these are the only duties to be performed by this employee. He or she will be required to follow other instructions and to perform any other duties requested by his or her Manager and/or Supervisor.

I have read and have been given a copy of this list of duties for my personal information.

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Employee Signature Date

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This job description has been developed to identify some of the duties and responsibilities of this position. It is not intended to limit or encompass all duties and responsibilities of the position.

Gateways Hospital and Mental Health Centers, at its sole and absolute discretion, expressly reserves the right to modify, supplement, delete or augment the duties and responsibilities specified in this and all job descriptions.