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Director of Nurse Credentialin...
To develop, implement, and monitor the credentialing and compliance process and standards of the external nursing staff of a Medicare certified home health agency by; offering information and opinion as a member of senior management; creating, monitoring, and implementing clinical and operational credentialing standards, processes/procedures. Oversee, manage, and audit the credentialing and compliance process of multiple medical disciplines in our offices throughout several western states.
Required Areas of Expertise:
· Federal regulations (Medicare)
· State regulations (Medicaid)
· Non-governmental regulatory agencies (JCAHO & CHAPS)
· Contractual & Insurance Compliance
· Clinical Audit Preparation and Response
· Qualitative and Quantitative Clinical Credentialing Measures ( Test/skills checklists )
· Protocol for each clinical space we work in; home health, facility staffing, etc.
· Employee background checks
· Human Resource Policies/Procedures
· Accomplishes clinical credentialing and compliance strategies by determining accountability; communicating and enforcing values, policies, and procedures; implementing recruitment, selection, orientation, training, coaching, counseling, disciplinary, and communication programs; planning, monitoring, appraising, and reviewing job contributions; planning and reviewing compensation strategies
· Develops credentialing and compliance organizational strategies by contributing information, analysis, and recommendations to strategic thinking and direction; establishing functional objectives in line with organizational objectives
· Establishes credentialing and compliance operational strategies by evaluating trends; establishing critical measurements; determining production, productivity, quality, and customer-service strategies; designing systems; accumulating resources; resolving problems; implementing change
· Develops compliance strategies by estimating, forecasting, and anticipating requirements, trends, and variances; aligning monetary resources; developing action plans; measuring and analyzing results; initiating corrective actions; minimizing the impact of variances
· Protects assets by establishing credentialing and compliance standards; anticipating emerging compliance trends; designing improvements to internal control structure
· Avoids legal challenges by understanding current and proposed legislation; enforcing regulations; recommending new procedures; complying with legal requirements
· Attracts new clients by maintaining state-of-the-art credentialing and compliance programs; bringing compliance recognition to the company; providing leadership in the industry
· Updates job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations
· Enhances credentialing, compliance and organization reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments