Credentialing Program Manager - Grady

We are more than a health system. We are a belief system. We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their own power to be healthy. We inspire hope. We learn, grow, and achieve more – in our careers and in our communities.

The Credentialing Program Manager reports to the Medical Affairs Manager. The primary purpose of the position is to direct, monitor and provide quality credentialing, re-credentialing and privileging processes to ensure that physicians and allied health practitioners meet applicable accrediting, legal, and regulatory standards.

Conducts, participates in, and maintains primary source verification.
Conduct, participates in, and maintains credentialing and privileging.
Manages the credentialing, recredentialing and privileging process.
Conducts, participates in, and maintains current clinical competency evaluations [FPPE/OPPE, proctoring].
Comply with accreditation and regulatory standards [TJC, ODH, CMS].

70% Credentialing - Core Functions of the Credentialing Program Manager:
Conduct, participates in, and maintains credentialing and privileging.
Completes evaluation of a credentialing application to determine applicant’s initial eligibility for privileges. Analyzes application and supporting documents for completeness.
Verifies and documents expirable using acceptable verification sources to ensure compliance with accreditation and regulatory standards.
Performs detailed and thorough review of applications, primary source verifications, and sources provided.
Independently investigates and validates the information and escalates findings as needed.
Recognizes potential discrepancies and adverse information, and independently investigates and validates information in applications, primary source verifications, or other sources.
Determines the applicant’s initial eligibility for privileges based on approved criteria.
Compiles, evaluates and presents the practitioner‑specific data collected for review by one or more decision‑making bodies.
Serves as the main point of contact for the practitioner during the application process, providing timely updates and additional information as requested.
Manages the credentialing, recredentialing and privileging process.
Uniformly applies clearly defined credentialing/privileging processes to all practitioners.
Evaluates credentialing/privileging requests and evidence of education, training, and experience to determine eligibility for requested privileges.
Complies with internal and external requirements related to verifying the status of all practitioner expirables (e.g. licenses, certifications) by querying approved sources and recommending actions to ensure compliance.
Completes quality review of all completed appointment/reappointment files which includes, file audit check list completion, all supporting documentation, all query requirements, and file organization.
Facilitates the review of Physician and Allied Health Practitioner credentialing files. Is an active participant on Physician Credentials Committee and/or Allied Health Practitioner Committee by compiling and presenting related materials for committee action and prepares report for the Medical Executive Committee and Board of Trustees for final approval.
Serves as liaison with clinical departments for the purpose of medical staff credentialing and privileging and collaborates with managers and directors of other hospital departments to ensure that Physicians and Allied Health Practitioners are only performing procedures for which they are…