Regional Director - Credentialing (Associate Director Health Care Standards), MPA Healthcare Improvement

Empower Every New Yorker - Without Exception - to Live the Healthiest Life Possible

NYC Health + Hospitals is the largest public health care system in the United States. We provide essential outpatient, inpatient and home-based services to more than one million New Yorkers every year across the city's five boroughs. Our large health system consists of ambulatory centers, acute care centers, post-acute care/long-term care, rehabilitation programs, Home Care, and Correctional Health Services. Our diverse workforce is uniquely focused on empowering New Yorkers, without exception, to live the healthiest life possible.

At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception. Every employee takes a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic communication and partnerships between all persons.

Job Description

Under direction of the Senior Director of Centralized Credentialing, The Regional Director develops, plans, coordinates and monitors the professional and medical aspects related to the delivery of health care services and assures the maintenance and compliance of quality care standards as mandated under Federal, State and local regulations. In collaboration with facility senior leadership such as, the Chief Medical Officer, president of medical staff, medical executive committee, and other facility leadership, formulates and implements policies related to health care standards. Supervises medical staff affairs and related credentialing activities for assigned sites within specified region.

General tasks and responsibilities will include:

• In conjunction with Central Office and facility leadership, formulates and develops policies and procedures for the monitoring and maintenance of health care standards to assure attainment of quality care and to meet mandated regulatory, legislative and administrative standards.
• Determine if clinical staff are meeting regulatory guidelines as well as the departmental objectives and goals, monitors and coordinates the credentialing review processes (including confidential background checks, such as: employment, training, malpractice, licensure verification, and professional misconduct), for health care standards.
• Develops operating policies for adherence to regulatory guidelines and standards.
• Coordinates functional activities of the Health Care Standards with other Corporate organizational units and maintains liaison with internal and external sources and with key officials.
• Provides guidance to health care facilities on managed care audits and TJC surveys and makes recommendations to improve effectiveness.
• Provides guidance to health care facilities for establishment and maintenance of policy and standards which conform to State, Federal and TJC requirements and counsels to resolve operating problems.
• Reviews City, State and Federal regulations relating to compliance reviews and advises key stakeholders on how to resolve / mitigate compliance issues.
• Provides leadership, training, and reviews performance of staff and makes recommendations to improve effectiveness and to assess quality standards of health care delivery.
• Advises Senior Director on policy and procedural changes, development of staff, implementation of productivity goals and makes recommendations for improvements in design of credentialing health care standards.
• Participates in meetings with System and facility leadership, attends seminars with health care groups, medical and professional health care organizations and hospital medical authorities related to special medical programs and health care standards.
• Supervises site leads within specified region and evaluates operational performance to implement corrective measures where needed.
• Provide temporary back-up coverage for other sites which may be outside of specified region.
• Other duties and special projects as assigned by the Senior Director of Centralized Credentialing.

Minimum Qualifications
1. Master's degree from an accredited college or university in Hospital, Health, Public or Business Administration, Healthcare Management, Public Health or a related discipline; and four (4) years of full-time, paid progressively responsible experience in hospital administration with an emphasis on the development and evaluation of health care delivery services; or
2. Bachelor's degree from an accredited college or university in disciplines, as listed in #1 above; and five (5) years of full-time, paid experience, as described in #1 above.

Department Preferences

Knowledge, abilities, education, experience and/or skills:

• MDStaff
• Credentialing Application Systems
• Primary Source Verifications
• CPCS/CPMSM
• Experienced with Sanction query/investigation including but not limited to NPDB, OIG, OMIG, SAM, OPMC, OFAC, Medicare OptOut, Medicaid-Exclusion, Social Security Death Master Query
• Familiar with internal/external credentialing regulations including The Joint Commission (TJC), NY State, CMS, NCQA, Managed Care plan, Facility Bylaws, Credentialing Policy & Procedures etc.
• Ability to perform data analysis to identify the areas of improvement, build credentialing QI dashboard

If you wish to apply for this position, please apply online by clicking the "Apply for Job" button.

If applying online, please include your cover letter in the same file attachment with your uploaded resume.

NYC Health and Hospitals offers a competitive benefits package that includes:

• Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
• Retirement Savings and Pension Plans
• Loan Forgiveness Programs for eligible employees
• Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
• College tuition discounts and professional development opportunities
• Multiple employee discounts programs