This is a description of a Staff Position Classification. It is not an announcement of a position opening. To view descriptions of current openings, please go to UNMJobs and Search Postings to view positions that are currently accepting applications.
The following statements are intended to describe, in broad terms, the general functions and responsibility levels characteristic of positions assigned to this classification. They should not be viewed as an exhaustive list of the specific duties and prerequisites applicable to individual positions that have been so classified.
Under limited supervision, oversees the credentialing and/or privileging operations within the UNM hospital, or other clinical entity. Plans, develops, manages and monitors processes and procedures ensuring quality in conducting, maintaining, and communicating physician or provider credentialing and privileging. Serves as the subject matter expert for credentialing and/or privileging, and collaborates with others to advance the quality of practitioners and patient safety, ensuring ongoing compliance with the accrediting and regulatory agencies. Supervises staff in the day-to-day management of the overall credentialing and/or privileging functions.
Duties and Responsibilities
Manages and oversees the administrative and daily accreditation, credentialing, and privileging operations for the University's hospital, or other clinical entity, ensuring compliance with university, state, and federal policies and regulations.
Oversees the supervision of personnel, which includes recruitment, work allocation, training, promotion, enforcement of internal procedures and controls, and problem resolution; evaluates performance and makes recommendations for personnel actions; motivates employees to achieve peak productivity and performance.
Manages the review and analysis process of credentialing applications following primary source verification, re-privilege and expansion requests, and credentialing and privileging by proxy requests; ensures the credentialing and privileging database is continuously updated and maintained with accurate data; prepares files for review and recommendation by the department leadership.
Engages senior leadership to facilitate credentialing and/or privilege development, maintenance and regular review of specialty-specific criteria; interfaces with technical personnel, academic administrators, external credentialing bodies, and other partners to ensure accurate compilation, retention, and submission of data.
Facilitates the organization medical staff committee process with oversight of agenda, minute taking, credentials summary preparation, and committee follow up.
Collaborates with and provides orientation to medical staff leaders to assist them in carrying out functions of the medical staff organization.
Conducts, participates in, and maintains current clinical competency evaluations and peer review; oversees staff to coordinate, track and monitor the medical staff Professional Practice Evaluation program.
Maintains current knowledge of credentialing and privileging rules, regulations, and policies and procedures; manages compliance with accreditation, credentialing and privilege standards and regulatory requirements.
Assists in establishing and implementing short- and long-range goals, objectives, policies, and operating procedures.
Reviews and ensures accurate completion and timely submission of governmental, University, and other reports as required, with respect to assigned areas of responsibilities.
Performs miscellaneous job-related duties as assigned.
Minimum Job Requirements
Successful completion of at least 60 college-level credit hours; at least 5 years of experience directly related to the duties and responsibilities specified. Certification/Licensure: NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) or actively pursuing certification.
Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis.
Knowledge, Skills and Abilities Required
Knowledge of clinical privilege criteria development.
Extensive knowledge of related accreditation requirements.
Extensive knowledge of medical credentialing and privileging procedures and standards.
Extensive knowledge of medical staff policies, regulations, and bylaws and the legal environment within which they operate.
Working knowledge of clinical and/or hospital operations and procedures.
Program planning and implementation skills.
Ability to serve on task forces and/or committees.
Skill in examining and re-engineering operations and procedures, formulating policy, and developing and implementing new strategies and procedures.
Skill in organizing resources and establishing priorities.
Ability to make administrative/procedural decisions and judgments.
Ability to develop and deliver presentations.
Ability to supervise and train employees, to include organizing, prioritizing, and scheduling work assignments.
Ability to communicate effectively, both orally and in writing.
Ability to foster a cooperative work environment.
Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community, including executive management and medical staff leadership.
Database management skills to include credentialing software, with ability to organize information and data to identify/explain trends.
Employee development and performance management skills.
Exhibits confidence and professional diplomacy.
Demonstrates an understanding of the interrelationships, roles, decision-makers, and responsibilities of the organization.
Demonstrates an understanding of concepts, key functions, terminology, and work products of risk management, human resources, clinical competence evaluation, legal, information technology, and performance improvement.
Conditions of Employment
Employees who provide services or work in patient care or clinical areas are required to be in compliance with the University's influenza vaccination requirement.
Working Conditions and Physical Effort
No or very limited exposure to physical risk.
No or very limited physical effort required.
Work is normally performed in a typical interior/office work environment.
The University of New Mexico provides all training required by OSHA to ensure employee safety.