BJC HealthCare is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois and mid-Missouri regions. BJC serves patients and their families in urban, suburban and rural communities through its 15 hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long-term care and hospice.
The Credentialing Verification Organization (CVO) is part of BJC HealthCare's Managed Care department. The CVO provides effective systems interface with all BJC Medical Staff Offices and establishes collaborative working relationships to ensure JCAHO, NCQA, and URAC compliance issues as they relate to physician credentialing. In addition, this team manages and provides oversight for cross credentialing efforts among BJC member organizations.
Leads the Credentialing Verification Organization (CVO), provider data management and related compliance activities for BJC HealthCare including 16 Hospitals, WUSM departments and 16 Managed Care plans. Directs system wide credentialing and primary source verification for physicians, nurses and allied health professionals. Leads Provider Data Management Center ensure accurate complete and timely collection and disposition of information. Ensures regulatory and accreditation compliance requirements are met. Provider Data Domain Trustee and project team member, responsible for the implementation and development of Data Governance processes to establish BJC standard data element definitions and linkage between source systems. Directs centralized verification functions supporting the credentialing process within the BJC facilities and entities. Coordinates all operational aspects and plans overall direction and integration of centralized verification services to meet system, legal and regulatory requirements. In addition, establishes short and long term goals that impact the enterprise verification processes, standardization of provider data within source systems, compliance with regulatory and accreditation standards while supporting the strategic initiatives and direction of the organization.
Manages individual(s) including but not limited to: hires, trains, assigns work, manages & evaluates performance, conducts professional development plans. Ensures that the productivity and actions of that group meet/support the overall operational goals of the department as established by department leadership. Develops and adheres to departmental staffing, revenue and/or expense budgets. Responds to changes in the business which may affect the ability to achieve the budget goals.
Directs daily operations of the BJC Credentialing Verification Office (CVO), providing credentialing and primary source verification for the Medical Staff Offices (MSO) within each of the BJC hospitals including BJC physicians, nurses, and allied health professionals. Liaises with BJC hospitals’ managers, directors, chief medical officers, Washington University School of Medicine, business managers within the various functional BJC departments in regard to physician and provider data (i.e. Human Resources, Patient Accounts, Finance, Medical Staff Offices, Registration, Pharmacy, Lab and Ancillary departments.)
Directs ongoing process development to streamline and improve service and efficiencies for onboarding and credentialing BJC’s physicians, nurses, and allied health professionals, while improving provider satisfaction. Applies the principles of continuous quality improvement in the delivery of services through assessment and monitoring of ECHO processes and systems including analysis of trends with implementation of changes as required.
Serves as Provider Data Domain Trustee and project team member, responsible for the implementation and development of Data Governance and MDM processes to establish BJC standard data element definitions and linkage between source systems. Partners closely with the Data Governance Committee, EPIC Project Team, Hospital Presidents, and local facility leadership (Medical Staff Services, Department Directors and Managers) Develops and implements systems to ensure continuous compliance with applicable regulatory and accreditation standards, i.e., The Joint Commission (TJC), the National Committee for Quality Assurance (NCQA), etc. Directs activities to meet requirements of the medical staff bylaws. Ensures the OPPE and FPPE modules within ECHO provider database support the ongoing professional practice evaluation and enhance the physician reporting activities required at the hospital level by accreditation and regulatory agencies.
Note: not all benefits apply to all openings
- Comprehensive medical, dental, life insurance, and disability plan options - Pension Plan*/403(b) Plan - 401(k) plan - Tuition Assistance - Health Care and Dependent Care Reimbursement Accounts - On-Site Fitness Center (depending on location) - Paid Time Off Program for vacation, holiday and sick time
*Pension does not apply to Memorial Hospital, Memorial Hospital East, Memorial Medical Group, Alton Memorial or Parkland Health Center
The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job. Equal Opportunity Employer