Quality And Privileging Manager (Remote

Overview

Cooper University Health Care is committed to providing extraordinary health care through our team, with ongoing clinical innovation and access to state‑of‑the‑art facilities, equipment, technologies, and research protocols. We offer competitive compensation and comprehensive benefits for full‑ and part‑time employees, plus opportunities for career growth through professional development.

Short description:
Responsible for facilitating the medical staff Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice Evaluation (FPPE) functions in accordance with The Joint Commission Standards, CMS Conditions of Participation, National Committee on Quality Assurance, and other regulatory requirements. Ensure that clinical reviews are timely, effective, and appropriately documented.

• Manage delineation of clinical privilege management; collaborate with the Department Chief and/or Division Head to solicit updates or modifications to privilege delineations to ensure forms reflect clinical practice and align with industry standards.
• For new privileges, compile information relevant to the privileges requested, including appropriate privilege criteria, position and opinion papers from specialty organizations, white papers from credentialing resources, and documentation from other health systems as appropriate.
• Facilitate provider changes in privileges credentialing, collaborating with providers and clinical departments to modify provider privileges for new privileges, department transfers, or changes in Medical Staff category/status.
• Oversee FPPE processes in coordination with Medical Staff Department Chiefs, Division Heads, and other clinical leaders; collect key data elements to ensure FPPE compliance and document accurately in provider files and the credentialing system; track timeliness of FPPE evaluations.
• In collaboration with clinical leadership, develop and oversee OPPE indicators to align provider performance data with Joint Commission accreditation standards and organizational goals; analyze assessment data to identify performance trends and potential risks to patient safety or organization.
• Monitor OPPE evaluations for timeliness; ensure comprehensive documentation in provider files and the credentialing system; manage the quality reporting platform (e.g., Premier or Vizient) for OEPE/OPPE profiles; prepare OPPE profiles for reappointment processes.
• Develop methods to efficiently manage FPPE and OPPE processes, including workflows, procedures, and compliance expectations consistent with CMS and TJC standards.
• Prepare and submit FPPE and OPPE reports to the Credentials Committee; participate in regulatory surveys and audits as the expert for FPPE/OPPE processes.
• Solicit updates to specialty‑specific delineations to keep forms current and aligned with clinical practice and industry standards; maintain privileges within credentialing software.
• Research privilege criteria for technologies or procedures new to the organization; interpret clinical nomenclature during credentialing (e.g., matching case logs to privileging criteria) and support staff in credentialing activities.
• Facilitate credentialing for providers requiring modifications to privileges due to additions, relinquishments, department transfers, or changes in Medical Staff category/status; coordinate with providers, clinical leadership, and Credentials Committee reviewers.
• Assist with other Medical Staff Office activities as identified and assigned.

• Five (5) years of clinical nursing experience.
• Five (5) years of progressively responsible professional experience managing databases in a healthcare setting.
• Analytical and quantitative skills for collecting, organizing, and summarizing data at multiple levels.
• Expertise querying clinical databases, using clinical decision software, and performing biostatistical analysis.
• Expertise with Microsoft Office; experience in performance improvement programs required.

• Bachelor of Science in Nursing (BSN) required and/or Master of Science in Nursing (MSN) preferred.

• Current RN licensure required;
  New Jersey RN licensure required with the following exception: remote RNs must hold licensure in the state of their primary residence.