Credentialing Program Manager

Job Overview The Credentialing Program Manager reports to the Medical Affairs Manager and/or Director. The primary purpose of the position is to direct, monitor and provide quality credentialing/privileging and re-credentialing/privileging processes to ensure physicians and allied health practitioners meet applicable accrediting, legal, and regulatory standards. The manager identifies and assesses areas of compliance according to TJC, ODH, CMS and other accreditation agencies, and serves as the content expert on the credentialing process for all inquiries from providers, hospitals, external agencies, and other stakeholders. The role involves a systematic, disciplined approach to maintain provider data accuracy and integrity, investigate and validate information, report trends, and lead process improvement activities. Responsibilities and Duties 70% Credentialing - Core Functions Conduct, participate in, and maintain credentialing and privileging processes. Evaluate credentialing applications for eligibility, completeness, and adherence to standards. Verify and document expirable items using accepted verification sources. Investigate discrepancies and adverse information independently, escalating findings as needed. Compile, evaluate, and present practitioner-specific data for committee review. Serve as the main point of contact for applicants, providing timely updates. Manage the credentialing, recredentialing and privileging processes uniformly across all practitioners. Perform quality reviews of all completed appointment/reappointment files. Assist in the review of physician and allied health practitioner credentialing files at Physician Credentials Committee and Allied Health Practitioner Committee. Collaborate with clinical departments to ensure practitioners perform only procedures for which they are privileged. Maintain current clinical competency evaluations (FPPE/OPPE, proctoring) and prepare related reports. Lead the development of new procedures and training pathways in collaboration with leadership. Conduct research on credentialing criteria and implement process improvements to increase efficiency. Lead the credentialing file review during regulatory and CMS surveys. Stay current on TJC, ODH, CMS requirements and governing document compliance. Participate in surveys, audits, and ongoing assessments of regulatory and accreditation agencies. 20% Organized Medical Staff Collaborate with leadership to develop and maintain delineation of privileges (DOPs) and complex departmental rules and regulations. Lead the onboarding process for new physicians and allied health practitioners, including orientation to the hospital, medical information systems, and resources. Coordinate activities to introduce new providers to medical staff leadership and hospital associates. Plan and facilitate medical staff meetings, including agenda creation, coordination with the chair, tracking follow‑up items, and compiling minutes for the Governing Body and external agencies. Manage billing and collection of medical staff dues, and create and manage purchase orders. 10% Data Management Maintain the credentialing database continuously to ensure accurate and current information. Manage the on‑call directory and ensure call schedules are accurate. Collaborate with providers to maintain accurate contact preferences. Maintain confidentiality regarding provider information, exercising high discretion and sensitivity. Audit and utilize practitioner credentialing processes and information systems to maintain data integrity. Identify trends, problems, and cause‑effect relationships, and participate in special projects as needed. Minimum Qualifications Bachelor's Degree (required). 7+ years of experience in healthcare, managed care, credentialing or medical staff services, or an equivalent combination of education and experience. 2 years of experience in the healthcare, managed care, credentialing or medical staff services field is also acceptable with a degree. Specialized Knowledge & Desired Attributes In-depth knowledge of physician and allied practitioner credentialing processes and TJC, ODH, CMS requirements. Strong communication, organizational, interpersonal and customer service skills. Credentialing database management (Cactus or similar) and conflict resolution abilities. Critical thinking and problem‑solving skills. Preferred certifications: Provider Credentialing Specialist (CPCS) or Medical Staff Coordinator (CMSC). Work Schedule Day schedule. 40 hours per week. Department: Medical Staff Services. Equal Employment Opportunity OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all persons in all aspects of the associate‑employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment. #J-18808-Ljbffr Berger Health System