Director Professional Staff Services and Utilization Management, Tucson, AZ
Directs the operations of Professional Staff Services (PSS) Department and Utilization Management (UM) Department including the functions of credentialing/privileging, elected medical staff committee activities, peer review, call schedules, UM functions and Physician Advisors, professional staff bylaws and compliance with regulatory requirements. Manages the staff of the Professional Staff Services and UM Department. Works closely with officers of the Professional Staff, Department Directors, TMC Medical Directors, Administration and the Board Quality Care Committee to build and maintain effective collaboration between the Professional Staff and Tucson Medical Center.
Working knowledge of the Joint Commission standards and other regulatory requirements. Participates in Lean process improvement activities supporting Tier 4 activities.
Maintains confidential credential files on all members of the Professional and allied health staff. Information to include: Application, Addendum forms, current Arizona and other licensure State and Federal Controlled Substance certificates, malpractice insurance, education, training, clinical competence, peer reference (s), hospital affiliations, board certification, curriculum vitae, clinical privileges, NPDB, OID/GSA reports, background verification, and evidence of current CME and code of conduct issues.
Manages staff and contracted physician advisors, interviews, hires and trains, evaluates employee performance, delegates work assignments appropriately and manages performance problems including coaching, discipline and recommendations on terminations. Establishes collaborative relationship and facilitates effective communication with medical staff leadership, members of the professional staff, administration, legal counsel and hospital staff.
Monitors adherence to and analyzes variances from approved budget , assures efficient and cost effective operations.
Oversees the processing of professional staff applications for appointments/reappointments and attends the Credentialing Committee to offer consultative advice for the rules and regulations governing this process.
Demonstrates knowledge of current medical staff standards as relating to TJC, state medical association, HFCA and state regulations in addition to change in guidelines and methodology for medical staff. Remains current in field.
Works with internal and external entities to establish effective professional relationships to ensure the strategies of the department and Administration are supported and obtained.
Assists all departments of the organization in matters concerning the workings of the Professional Staff
Serves as lead for medical staff during regulatory compliance and accreditation surveys assuring remediation of findings and issues.
Ensures new members of the professional staff are oriented to all pertinent aspects of TMC as needed.
Maintains awareness and provides accurate interpretation of the TMC Professional Staff Bylaws and Rules and Regulations. Ensures these documents meet current regulatory standards and coordinates with the Legal Department on revisions.
Ensures the review of existing policies and governance documents on a regular basis and recommends changes to the Medical Executive Committee (MEC) as appropriate
Works directly with the elected officers of the Professional Staff in such a manner as to assure the provision of all necessary resources to enable them to properly perform their duties. Provides knowledge and expertise of regulatory and legal requirements governing the work of the Professional Staff.
Assists in the identification of potential new physician leaders and assists in the development of educational opportunities to prepare them. Evaluates needs of current leaders for educational updates and makes recommendations to CMO regarding needs.
Ensures effective committee functions including oversight of agenda development, documentation in the minutes and follow-up communications with key members and stakeholders.
Assists with the design, development, implementation, support and oversight of the Professional Staff Services Department activities, including Utilization Management.
Monitors appropriate compensation of the members of the elected professional staff as designated by contracting and compensation plans in keeping with the legal restrictions applicable.
Works with the Board Quality Care Committee (BQCC), MEC, the Credentials Committee, and Department Chairs on the creation of and/or revision of privileging forms, privileging criteria, competencies, and credentialing standards.
Oversees the professional staff peer review process for TMC. Ensures the peer review process is consistent, fair, and timely. Assists the physician leaders and executive team in evaluating the need for outside peer review when necessary.
Oversees the communication process to effectively transmit information to the members of the TMC Professional Staff.
Acts as a liaison between the Administration, the members of the Professional Staff, Hospital Department Directors and the community in an effort to obtain compliance and satisfaction with processes and procedures at TMC.
Carries out specific tasks assigned by the MEC including the planning, implementation, execution, and evaluation of projects.
Monitors the quality of the care provided by the Professional Staff by reviewing the quality indicators and medical record and peer review processes. When appropriate a referral to the peer review process will be generated.
Attends the Board Quality Care Committee.
Oversees physician utilization review for Tucson Medical Center providing expert advice and guidance for physicians and the UM Committee
Oversees the physician advisor role to review of Medicare and other health plan patients with respect to appropriateness of admission, level of care, continued stay and professional services furnished
Confers with attending physicians to obtain clinical information pertinent to medical necessity, specifically regarding admission, level of care, continued stay and/or resource utilization
Provides leadership development to supervisory staff for effective problem identification and resolution for efficient day-to-day operations. Determines staff learning needs and schedules in-service education programs.
Acts as a mentor and coach.
Oversees the delivery of quality services in areas of operations while developing and maintaining effective working relationships with internal and external customers.
Participates in varying degrees in the preparedness and response to external agencies (i.e. Department of Health Services, Medicare, etc.).
Supports quality improvement initiatives through team participation, data collection, process change implementations and other activities.
Participates in the preparation for and actual discussions with the medical directors of health plans and members of the professional staff to advocate for the patients and TMC
Oversees the coordination of UM rounds with the Case management department and Physician Advisors
Adheres to TMC organizational and department-specific safety, confidentiality, values, policies and standards.
Performs related duties as assigned.
Bachelor’s degree from an accredited institution in a clinical or healthcare related field.
Eight (8) years management experience in a healthcare related field.
LICENSURE OR CERTIFICATION: Current and active RN License permitting work in the state of Arizona; Certified Medical Staff Coordinator and/or Certified Provider Credentialing Specialist preferred.
KNOWLEDGE, SKILLS AND ABILITIES:
- Thorough knowledge of credentialing and privileging rules and regulations.
- Knowledge of Medical terminology, familiarity with professional staff training programs and residency/internship requirements, state and federal regulations and standards.
- Skill in leadership as evidenced by oral, written and electronic presentation to the departments of the Professional Staff and the Hospital.
- Skill in managing staff and evaluating performance.
- Ability to form collaborative relationships and maintain effective and responsive interpersonal skills..Excellent written and oral communication skills.
- Ability to prepare detailed written reports, budgets, and spreadsheets providing database management oversight.
- Ability to apply critical thinking skills and recommend improvements for efficiency.