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.