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Company: Emerus Holdings Inc.
Location: Houston, TX
Career Level: Director
Industries: Healthcare, Pharmaceutical, Biotech

Description

This leadership role is responsible for managing the Credentialing Verification Office (CVO) and overseeing the medical administrative and medico-legal functions of the medical staff organizations. The position also ensures effective credentialing and enrollment processes are compliant with DNV, NCQA, CMS, and other applicable accrediting standards. In collaboration with the Chief Medical Officer, the Director of Medical Staff Services, serves as a vital liaison to foster clear communication and strong, positive working relationships.



Basic Qualifications

  • Bachelor's degree in Business Administration, management or healthcare-related field. May consider 10 years of Medical Staff Services experience in a supervisory role in lieu of degree.
  • CPMSM Certification from the National Association of Medical Staff Services
  • Minimum of 10 years' supervisory experience in Medical Staff Services in a multi-facility acute care hospital system
  • Strong knowledge of accreditation standards with DNV, state and federal laws
  • Extensive knowledge of credentialing software programs, required
  • Comprehensive knowledge of medical staff office functions and responsibilities required.
  • Work requires knowledge of medical-legal issues and awareness of the legal ramifications of hospital documentation and hospital and physician liability.
  • Strong proficiency with Microsoft Office Suite required
  • Position requires fluency in English and extensive knowledge of medical terminology and technology; written and oral communication


Essential Job Functions

This position requires exceptional interpersonal skills to manage sensitive and confidential matters with discretion. A high level of poise, tact, and diplomacy is essential when interacting with influential individuals both within and outside the hospitals. Strong analytical abilities, independent problem-solving, and sound decision-making are critical for effectively addressing complex administrative and medical staff issues in a fast-paced environment. The role also demands flexibility, adaptability to frequent interruptions, and the ability to manage a dynamic work schedule. The ideal candidate demonstrates intelligence, a commitment to continuous improvement, self-direction, integrity, and consistently models professional behavior.

 

▪ Ensure that the organization and staff are in accordance with organizational, client, and industry standards and regulations (CMS, NCQA, DNV, etc.)

▪ Maintain the accuracy of the credentialing database.

▪ Assist/coach/coordinate with team leads consistently, as well as with other departments.

▪ Provides leadership to establish credentialing best practices and oversee the credentialing process to meet targeted go-live dates for new/existing hospitals.

▪ Develops processes for scaling operations and summarizes the complexity of data and operations into clear expectations.

▪ Identifies and implements process efficiencies to ensure a streamlined approach to credentialing.

▪ Develops and implements a quality program to ensure accuracy of information and timeliness of submissions.

▪ Supports credentialing regulatory activities and reporting any risks to compliance and leadership.

▪ Provides analytical support and leads the process of collecting, analyzing, and reporting credentialing metrics.

▪ Research government and state requirements for credentialing in new markets and collaborate with other leaders to identify issues and opportunities that lead to achieving department and company goals.

▪ Builds relationships with JV partner insurance plans and confirms that the credentialing process is current based on insurance requirements.

▪ Performs other related duties as assigned or needed for business continuity.



Other Job Functions

  • Attend staff meetings or other company sponsored or mandated meetings as required
  • Perform additional duties as assigned
  • Ability to work off-hours and on call when required


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