Privileging Program Manager

Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that’s served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It’s our passion.

Primary Purpose

Supports multiple areas of business and clinical operations surrounding new devices, privileging, technology for evaluation in relation to physicians and advanced practice providers (APP). Responsible for developing the privilege and monitoring criteria for new devices, procedures, technology or treatments and the development of policies. Maintenance of all delineation of privilege sets and policies with a regular review schedule. Reports to the Director of Medical Staff Professional Services. Responsible for the daily management of Medical Staff Professional Services privileging activities including development, collaboration, and planning. Ensure that the work operations meet internal/external standards for Parkland and affiliated institutions.

Minimum Specifications

Education

• Bachelor's degree health administration, business administration or related field.

Experience

• Must have six (6) years of expert level Medical Staff Professional Services experience in hospital setting, clinical practice, or managed care that is related to healthcare administration programs such as privileging, credentialing, peer review, professional performance evaluation, quality improvement/assurance, provider education, legal and compliance, risk management/prevention or internal/regulatory audit is required.
• Must have two (2) years of experience working with elements of the Professional Performance Evaluation (FPPE/OPPE) standards.
• Two (2) years of experience in provider data management is preferred.

Certification/Registration/Licensure

• Must be certified by the National Association Medical Staff Services (NAMSS) as a Certified Professional in Medical Services Management (CPMSM) or a Certified Provider Credentialing Specialist (CPCS). within one twenty-four (24) months of hire or placement in job.

Skills or Special Abilities

• Must have comprehensive knowledge of hospital accreditation, medical/allied staff credentialing, privileging, appointment, and licensure requirements, as well as management of governance documents.
• Must have excellent oral and written communication skills and be able to communicate effectively with Medical Staff, hospital management, and staff level personnel.
• Must have strong analytical skills to evaluate complex situations, ability to formulate decisions, and execute a plan of action.
• Must understand risk management concepts, such as identifying, monitoring, and managing potential risks in order to minimize the negative impact on organization.
• Must have the ability to act on own initiative and assume responsibility for such initiatives.
• Must establish productive, cooperative, positive relationships with peers, management, and stakeholders both internal and external to the organization.
• Must possess the ability to understand and respond to others' needs and priorities. Give and seek feedback that will increase the productivity of relationships and networks with peers and associates to build a support base.
• Must have experience using MD-Staff or other credentialing/privileging software.
• Oversee outreach to primary sources for practitioners' information, ensuring staff are accurately obtaining and evaluating privileging information from primary sources.
• Serve as liaison between internal technical staff as well as outside technology vendors.
• Must be able to organize work, set priorities, and determine short or long-term goals and strategies to achieve them.
• Must have the ability to align communication, people process and resource to drive success.
• Must be committed to continuous performance and process improvement.
• Must have the ability to collaborate and share plans, information, and resources with team.
• Must be able to encourage and facilitate cooperation, trust, and group identity; and build commitment, team spirit, and strong relationships.
• Must have the ability to work collaboratively and relate effectively to others by practicing, valuing, embracing diversity of individuals, and fostering respect and equity in the workplace.
• Must be committed in fostering a team-dynamic and cohesive, collaborative department with an entirely remote workforce.
• Prefer - Knowledge of the Texas Department of Insurance, the Office of the Inspector General and other state agencies involving claims and Fraud, Waste and Abuse programs.
• Prefer - Intermediate knowledge of Joint Commission, NCQA, CMS and other local, state, and national regulations/standards.
• Prefer - Functional awareness of CPT, ICD10, DRG, as well as Taxonomy codes.
• Prefer - Advanced proficiency in Microsoft Excel to include VLOOKUP, creating complex function and equations.
• Prefer - Proficiency in Adobe Pro and Microsoft Outlook.
• Prefer - Experience using SharePoint.

Responsibilities

1. Facilitates Medical Staff Professional Services privileging operations including, but not limited to the following: reviewing new devices, procedures, technology, and treatment for evaluation in relation to physicians and advance practice professionals.
2. Responsible for identifying and developing new privileges in collaboration with the physician(s) in all applicable medical staff departments and sections all applicable privilege sets for new devices, procedure, technology, and treatment, to include implantation and management.
3. Responsible for coordinating the approval process for all new devices, procedures, technology, and treatments.
4. Responsible for developing a maintenance schedule for a privilege set review with the medical staff department and section chiefs.
5. Responsible for developing physician specific monitoring criteria for new devices, procedures, technology, and treatments for Focused Professional Practice Evaluation (FPPE)
6. Coordinate Emergency Meetings for Compassionate and Emergency Use for new devices, procedures, technology, or treatment that are non-FDA approved.
7. Develop Temporary Emergency and Compassionate Use privileges in conjunction with Legal and obtain the appropriate signatures and approvals within minimal time frames.
8. Member of the Credentialing and Privileging Committee (non-voting) and other committees as assigned.
9. Provides support to all privileging activities.
10. Responsible for the administration of the privilege training program to MSPS team and ensuring all required training is completed on time.
11. SUBJECT MATTER EXPERT:
    1. Collaborate with Clinical Chiefs to design, deploy & implement privileging approaches that result in efficiency, improved processes, or systems.
    2. Participate in training/orientation for Clinical Chiefs, Parkland leaders, & care delivery managers, as needed.
    3. Contributes expert guidance & consultation to department chiefs & hospital leadership for TJC Medical Staff Standards.
    4. Assist legal counsel & defense attorneys w/ legal cases or fair hearing proceedings as it relates to the subject matter.
    5. Serve as non-voting member of the Privileging and Credentials Committees.
    6. Stay abreast of new and pending TX legislation, regulatory & accreditation standard changes related to credentialing & clinical privileges.
    7. Maintain a thorough knowledge of and ability to interpret accreditation standards & regulatory requirements as well as Parkland Health standards related to credentialing & clinical privileges.
    8. Maintain a thorough knowledge of Professional Staff Bylaws, Rules & Regulations for Parkland Health
12. Ensures Medical Staff professional Services privileges for the medical staff, and appropriate health professionals are coordinated in a thorough, accurate and timely manner.
13. Ensures timely and proper notification regarding any probable privilege changes involving peer reviewed cases.
14. Serves as the operational liaison and subject matter expert for all Privileging activity and workflow across the organization, regulatory agencies, and internal and external Parkland constituents.
15. Effectively develops and executes project plans.
16. Closely collaborates with Parkland's strategic leadership team, medical staff committees and regulatory agencies and associations.
17. Develops and executes privileging management tools, programs, policies, and procedures to drive provider satisfaction and continuous performance improvement.
18. Performs other duties as assigned to support the business plan.
19. Collaborates with MSPS Support Services on Medical Staff Privileging committee meetings, as appropriate. Provides all necessary meeting documents and assists Medical Staff Professional Services leadership with expeditious follow-up of privileging committee actions and policy changes.

Job Accountabilities

1. Identifies and analyzes the design of jobs, work processes, workflows, etc. for the area and implements appropriate changes to improve effectiveness, productivity, and efficiency that support the overall goals of the department and Parkland.
2. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
3. Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.
4. Develops and monitors annual budgets that ensure the department has the necessary funds to carry out the goals and objectives that have been established for the department.
5. Develops, implements, monitors, and revises annual goals and objectives for the department that support the missions and objectives of Parkland.
6. Selects, trains, schedules, motivates, supervises, and evaluates employees making recommendations for disciplinary actions up to and including termination, to ensure maximum utilization of individual and group capabilities. Ensures that assigned employees receive opportunities to further their knowledge.

Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status. As part of our commitment to our patients and employees’ wellness, Parkland Health is a tobacco and smoke-free campus.