At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.
Job Summary
The Director, Centralized Credentialing is responsible for the strategic leadership, oversight, and operational effectiveness of the enterprise-wide centralized medical staff credentialing function across all facilities within the organization. This role ensures consistent, compliant, and efficient credentialing and privileging processes in accordance with federal and state regulations, accreditation standards, Medical Staff Bylaws, and organizational policies. The Director leads centralized credentialing staff, partners closely with hospital leadership, medical staff leadership, legal, and regulatory teams, and drives standardization, quality, and continuous improvement across the credentialing lifecycle.
Essential Functions
* Provide enterprise leadership for all aspects of centralized medical staff credentialing and privileging across assigned facilities.
* Ensure compliance with CMS Conditions of Participation, Joint Commission (or other accrediting body) standards, state regulations, and Medical Staff Bylaws, Rules, and Regulations.
* Develop, implement, and maintain standardized credentialing and privileging policies, procedures, workflows, and internal controls.
* Partner with Medical Staff leadership, hospital executives, Quality, Legal, and Compliance teams on credentialing-related matters, including practitioner eligibility, adverse actions, and bylaw interpretation.
* Oversee the credentialing of physicians and other licensed independent practitioners, including initial appointments, reappointments, privileging, and ongoing professional practice evaluation (OPPE/FPPE) support as applicable.
* Lead, coach, and develop centralized credentialing management and staff, including performance management, training, and succession planning.
* Establish and monitor key performance indicators (KPIs) related to credentialing timeliness, quality, and compliance.
* Oversee the use, optimization, and vendor management of credentialing software and related systems.
* Support facilities during regulatory surveys, audits, and medical staff reviews, including preparation, onsite support, and follow-up actions.
* Collaborate with facility CEOs and medical staff offices through regular communication and relationship-building to ensure service quality and alignment.
* Manage departmental budget, contracts, and resource planning.
* Identify opportunities for process improvement, standardization, and automation to enhance efficiency and reduce risk.
* Maintain strict confidentiality of practitioner, patient, and organizational information.
* Perform other duties as assigned in support of organizational objectives.
Knowledge/Skills/Abilities/Expectations
* In-depth knowledge of medical staff credentialing, privileging, and regulatory requirements.
* Strong understanding of CMS Conditions of Participation and accreditation standards.
* Proven leadership, team development, and change-management skills.
* Excellent written and verbal communication skills with the ability to interact effectively at all organizational levels.
* Strong analytical, problem-solving, and decision-making capabilities.
* Ability to manage competing priorities in a fast-paced, deadline-driven environment.
* High level of professionalism, discretion, and integrity.
* Proficiency with credentialing software systems and Microsoft Office applications.
* Primarily sedentary work with prolonged periods of sitting and computer use.
* Occasional standing, walking, and lifting of materials up to 25 pounds.
* Visual and auditory acuity required for meetings, document review, and system use.
* Office and remote work environment with periodic travel to facilities.
* Occasional exposure to healthcare facility environments.
* Estimated travel: up to 20%, based on organizational needs.
Education
* Bachelor's degree in Healthcare Administration, Business Administration, Nursing, or a related field preferred.
Licenses/Certifications
* Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) required.
Experience
* Minimum of 5 years of progressive medical staff credentialing experience in an acute care healthcare environment required.
* Prior experience supporting multiple facilities or enterprise-level credentialing operations strongly preferred.
* Demonstrated experience with Joint Commission and CMS surveys required.
* Prior leadership or management experience required.
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