Los Angeles, CA30+ days ago
p>Leadership and Training: Leads training and regulatory awareness by: guiding team to and independently facilitating orientation and training to newly appointed physician leaders for effective oversight and management of their departments credentialing, proctoring, privileging and reappointment processes; supervising team to and independently developing complex informational/educational documents (newsletters, memos) to communicate critical information regarding organizational programs and policies; supervising the development and cultivation of working relationships with key stakeholders, both internal and external, to ensure appropriate awareness of key issues and decision-making; guiding team to facilitate meeting with leadership to develop on-boarding processes (orientation, training activities) to assist practitioners/providers and to meet education requirements; updating applicable governing documents (bylaws, rules and regulations/policies and procedures) that support and direct organizational practices and ensure compliance; and maintaining awareness of current internal policies and external regulations, and legislation.
Quality Assurance, Improvement, and Resolution:
Ensures quality assurance, improvement, and resolution by: guiding and supervising team to obtain and evaluate practitioner sanctions, complaints, and adverse data to ensure compliance; supervising and evaluating ongoing assessments of governing documents (e.g., bylaws/rules and regulations/policies and procedures) to ensure continuous compliance; maintaining collaborative efforts and may be participating in surveys and audits of credentialing entities (e.g., CMOs, delegates and health plans for NCQA); guiding team of techniques and strategies to facilitate efficient and cost-effective due process that complies with internal fair hearing and appeals policies and external legal and regulatory requirements; evaluating team identification, resolving, escalating as needed, and responding to adverse actions/issues (e.g., sanctions and complaints) taken against a practitioner/provider in accordance with applicable law and contractual requirements to the necessary parties; and guiding team to audit and reconcile data between different departments for consistency, and monitoring of credentialing and contracting.