Position Classification Description

Position Class Code / Title: A8025 / Dir,Med Staff Qlty Compliance
Recruitment Tier: Tier 1
FLSA: Exempt
Grade: 16

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.

Summary

Leads process-improvement activities across clinical and medical staff affairs for multi-components of the UNM Health System, in support of patient safety, quality care, and continued improvement for excellence in an enterprise-wide healthcare delivery system. Collaborates with key stakeholders in areas of strategic decision making for the health system to design, achieve, and sustain integrated processes. Manages the development and implementation of strategic components associated with clinical and medical staff affairs within the UNM Health System.

Duties and Responsibilities

  1. Provides strategic leadership on process-improvement activities across the UNM Health System to ensure consistency, standardization, consolidation, effectiveness, cost containment, and efficient processes in compliance with all local, state, federal regulations, and regulating bodies.
  2. Establishes and implements short- and long-range enterprise-wide organizational goals, objectives, strategic plans, policies, and operating procedures; monitors and evaluates programmatic and operational effectiveness; and strategically aligns and integrates policies, programs, and initiatives to ensure a coordinated and supportive infrastructure for the UNM Health Systems.
  3. Serves in an advisory capacity to the Clinical Affairs Deans, Chief Medical Officers (CMOs), department chairs, campus department chiefs, and other elected UNM Health Systems medical staff officers and committee chairpersons, in matters relating to credentialing, privileging and medical staff affairs.
  4. Ensures efficient processes and accountability for collection, verification, management and flow of practitioner-specific data into and out of various databases and throughout the health system.
  5. Directs the collection and presentation of practitioner-specific data for review by decision-making bodies, ensuring flow of accurate information to Health System Governing Boards.
  6. Leads the execution of delegated credentialing programs to ensure compliance with managed care contracts and provider participation for government and commercial billing.
  7. Manages and oversees health plan audits and develops corrective action plans as needed.
  8. Ensures implementation of policies and procedures related to compliance with accreditation standards, regulatory requirements, and Medical Staff bylaws.
  9. Develops and manages annual budgets for the organization and performs periodic cost and productivity analyses.
  10. Oversees the supervision of personnel, which includes 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.
  11. Maintains currency of knowledge with respect to the University's strategic directions and plans, and in the professional environment of medical staff services.
  12. Performs miscellaneous job-related duties as assigned.

Minimum Job Requirements

  • Master's degree; at least 4 years of experience directly related to the duties and responsibilities specified. Certification/Licensure NAMSS as Certified Professional in Medical Services Manager (CPMSM) and Certified Provider Credentialing Specialist (CPCS).
  • 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

  • Ability to successfully direct, coordinate, and strategically integrate the credentialing, privileging, and medical staff governance functions at the health system level.
  • Ability to strategically integrate and impact functions relating to onboarding and entry of practitioners into the health system, enrollment and compliance functions that directly impact the revenue cycle.
  • Knowledge of current developments and trends in credentialing, privileging, medical staff governance, and practitioner database management theory and practice.
  • Knowledge of current regulatory requirements relevant to medical staff services, to include; CMS Conditions of Participation, The Joint Commission, NCQA, DNV, AAAHC, and URAC standards, as well as and the New Mexico Office of Superintendent of Insurance.
  • Knowledge and understanding of the Project Management and Healthcare Quality bodies of knowledge.
  • Skill in credentialing database management and software solutions, with ability to adopt and promote new modalities to improve workflows and efficiencies.
  • Knowledge and understanding of organization structure, workflow, and operating procedures.
  • Skill in examining and re-engineering operations and procedures, formulating policy, and developing and implementing new strategies and procedures.
  • Demonstrated ability to develop and implement short- and long-range systems, capacity, technology, and operational plans.
  • Knowledge of University business practices and procedures.
  • Ability to effectively manage and grow a diverse team of professional and support staff and to foster an excellent customer service environment.
  • Ability to analyze complex problems, interpret operational needs, and develop integrated, creative solutions.
  • Advanced verbal and written communication skills and the ability to present effectively to small and large groups.

Conditions of Employment

  • Must maintain certification status.

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.

Revised Date: 02/01/2018