Supervisory Health System Specialist (Credentialing and Privileging Manager)
The incumbent in this position will oversee all functions related to healthcare providers' professional credentials supporting all divisions of the VAMC in accordance with VHA Credentialing and Privileging (C&P), Directives, VA Handbooks, Policies, Memos, and Notices; The Joint Commission (TJC) Standards and State and Federal Regulations. Other duties and responsibilities include but are not limited to the following:
Works collaboratively with local and VISN leadership to identify and/or implement best practices and advising VAMC leadership of all program requirements pertaining to the C&P program. Ensures quality assurance and provides oversight for the VAMC C&P program. Ensures that the Medical Staff Bylaws/Rules and Regulations are reviewed annually and updated (as needed or a minimum of every two years) to reflect regulations or accreditation standards. Serves as the VAMC's Senior Technical Advisor and as the primary consultant and liaison to the VISN C&P Officer. Outlines VAMC C&P program goals and objectives, identifies risks, supervises all VAMC C&P employees, ensures training and education, and completes second level reviews as appropriate. As the VAMC's C&P Program subject matter expert (SME), the incumbent provides direct technical and administrative supervision to employees in the VAMC's C&P Office. Manages the C&P staff; sets and adjusts short and long-term priorities; assesses staffing needs; plans work to be accomplished; and ensures positions are appropriately manned to cover all program functions; Conducts staff meetings and composes minutes. Develops, modifies, and/or interprets performance standards; outlines and explains performance expectations to staff; assigns and reviews work performed by subordinates based on priorities, evaluates work performance mid-year and annually. Serves as approving official for leave requests and approving official for credit card purchases and reconciliations Interviews and selects candidates for vacancies, promotions, details and reassignments Provides consulting and guidance to local leadership and C&P employees on all matters pertaining to the facility's C&P program including Healthcare Professionals' C&P; facility Scope of Practices; National and VISN Memorandums of Understanding (MOUs); Veterans' Administration Memorandums; VHA requirements, Handbooks, Directives and Policies; TJC Standards; quality assurance assessments; and risk management and malpractice claim action evaluations. Analyzes program audit results; interprets facility quarterly report card data; researches provider credentialing requirements; identifies potential privileging issues; drafts facility Medical Staff Bylaws updates and revisions; interprets and explains new regulatory requirements, and VHA requirements, procedures and processes; contributes to development of local policies; ensures program compliance; monitors National Practitioner Databank reporting and queries results; prepares Federal and State Medical Boards reports; tracks State Licensing Board reporting; communicates telehealth provider requirements; manages VetPro access levels and training; assists with Joint Commission surveys, and Office of Inspector General and Government Accountability Office reviews. Coordinates with Service Chiefs and service level administrative teams for annual Committee(s) review of clinical privileges and scope of practice forms; reviews clinical privileges and scope of practices for accuracy, setting specific indicator and signature appropriations as required for VAMC compliance with Joint Commission Standards; updates clinical privilege forms to reflect procedures added or deleted. Coordinates with telehealth program team to ensure compliance. Performs as the VAMC SME on the following topics, including, but not limited to credentialing of licensed independent practitioners (LIP) and Non-LIPs; privileging and privileging related matters including focused and ongoing professional practice; adverse privileging actions; Reporting to the National Practitioner Data Bank (NPDB); and reporting to State Licensing Boards (SLB). Provides subject matter expert guidance to VAMC leadership related to credentialing, privileging, adverse privileging actions, NPDB reporting, and SLB reporting. Serves as liaison and partner with Human Resources Service programs for common program goals and issues including, but not limited to, provider onboarding, provider exit reviews and assessments, privileging actions, and guidance related to clinical performance concerns. Serves as the administrator for the TRJC. This involves managing enrollments, single queries and re-enrollments; preparing and submitting reports for adverse privileging actions; submitting federal tort claims for substandard clinical care per the OIG Counsel; ensuring that primary source verification is obtained and processed via quality control review. Serves as the administrator for the Federation of Medical Boards To qualify for this position, applicants must meet all requirements by the closing date of this announcement. Time-In-Grade Requirement:
Applicants who are current Federal employees and have held a GS grade any time in the past 52 weeks must also meet time-in-grade requirements by the closing date of this announcement. For a GS-12 position you must have served 52 weeks at the GS-11. The grade may have been in any occupation, but must have been held in the Federal service. An SF-50 that shows your time-in-grade eligibility must be submitted with your application materials. If the most recent SF-50 has an effective date within the past year, it may not clearly demonstrate you possess one-year time-in-grade, as required by the announcement. In this instance, you must provide an additional SF-50 that clearly demonstrates one-year time-in-grade. You may qualify based on your experience as described below:
Specialized
Experience:
You must have one year of specialized experience equivalent to at least the next lower grade (GS-11) in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include, but are not limited to:
Experience working in a Medical Staff Credentialing Office Credentialing and Privileging experience (for both licensed independent practitioners as well as all other dependent practitioners). Experience providing direct technical and administrative supervision to employees (tasks may include:
sets and adjusts short and long-term priorities; assesses staffing needs; plans work to be accomplished; ensures positions are appropriately manned to cover all program functions, etc.). Experience providing consulting and guidance to local leadership and Credentialing and Privileging employees on all matters pertaining to the facility's Credentialing and Privileging program. Knowledge and skill in applying analytical and evaluative methods and techniques to issues or studies concerning the efficiency and effectiveness of the facility's medical staff functions and C&P Program operations. Knowledge of pertinent laws, regulations, policies and precedents; accreditation standards and guidelines, including, but not limited to:
TJC, VHA Handbooks, Directives, Memos, and Notices; VetPro Policies/Standard Operating Procedures; and local medical center policies related to the principles, practices and program goals of the C&P program. Knowledge of the principles, provisions and practices of credentialing and accreditation and regulatory agencies such as TJC, Office of Inspector General/Combined Assessment Program (OIG/CAP) and Government Accountability Office (GAO). Knowledge and skill in Staffing regulations/requirements for health care practitioners for compliance with a range of National and Local Handbooks, Directives, MOUs, Policies, Medical Bylaws, etc.; internal and external regulatory and accrediting agencies such as TJC, CARF, URAC, and NPDB Experience working within the VetPro software (this includes:
expertise in utilization of the VetPro credentialing system including knowledge of the credentialing and privileging process, documentation of primary source verifications, and how to audit credentialing files and reporting functions). Knowledge of all VetPro policies including, but not limited to, VetPro Data Integrity, Current Appointments and Sharing Files, Facility Security Awareness and Training, and Facility Level Access control. Knowledge of medical specialties, medical terminology, and design and implementation of best practices for criteria based privileging systems for granting of clinical privileges and/or reduction and/or revocation of clinical privileges. Experience related to credentialing, privileging, adverse privileging actions, NPDB reporting, and SLB reporting. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religions; spiritual; community; student; social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience. Note:
A full year of work is considered to be 35-40 hours of work per week. Part-time experience will be credited on the basis of time actually spent in appropriate activities. Applicants wishing to receive credit for such experience must indicate clearly the nature of their duties and responsibilities in each position and the number of hours a week spent in such employment. Physical Requirements:
The work is mostly sedentary. Occasionally, light physical effort may be required, such as that involved with walking, stair climbing, and carrying of light office items. Work Environment:
The work is performed in an office setting which requires normal safety precautions typical for offices and meeting rooms. The work area is adequately lighted, heated, and ventilated. The work may require travel. For more information on these qualification standards, please visit the United States Office of Personnel Management's website at https:
//www.opm.gov/policy-data-oversight/classification-qualifications/general-schedule-qualification-standards/.
Estimated Salary: $20 to $28 per hour based on qualifications.
Works collaboratively with local and VISN leadership to identify and/or implement best practices and advising VAMC leadership of all program requirements pertaining to the C&P program. Ensures quality assurance and provides oversight for the VAMC C&P program. Ensures that the Medical Staff Bylaws/Rules and Regulations are reviewed annually and updated (as needed or a minimum of every two years) to reflect regulations or accreditation standards. Serves as the VAMC's Senior Technical Advisor and as the primary consultant and liaison to the VISN C&P Officer. Outlines VAMC C&P program goals and objectives, identifies risks, supervises all VAMC C&P employees, ensures training and education, and completes second level reviews as appropriate. As the VAMC's C&P Program subject matter expert (SME), the incumbent provides direct technical and administrative supervision to employees in the VAMC's C&P Office. Manages the C&P staff; sets and adjusts short and long-term priorities; assesses staffing needs; plans work to be accomplished; and ensures positions are appropriately manned to cover all program functions; Conducts staff meetings and composes minutes. Develops, modifies, and/or interprets performance standards; outlines and explains performance expectations to staff; assigns and reviews work performed by subordinates based on priorities, evaluates work performance mid-year and annually. Serves as approving official for leave requests and approving official for credit card purchases and reconciliations Interviews and selects candidates for vacancies, promotions, details and reassignments Provides consulting and guidance to local leadership and C&P employees on all matters pertaining to the facility's C&P program including Healthcare Professionals' C&P; facility Scope of Practices; National and VISN Memorandums of Understanding (MOUs); Veterans' Administration Memorandums; VHA requirements, Handbooks, Directives and Policies; TJC Standards; quality assurance assessments; and risk management and malpractice claim action evaluations. Analyzes program audit results; interprets facility quarterly report card data; researches provider credentialing requirements; identifies potential privileging issues; drafts facility Medical Staff Bylaws updates and revisions; interprets and explains new regulatory requirements, and VHA requirements, procedures and processes; contributes to development of local policies; ensures program compliance; monitors National Practitioner Databank reporting and queries results; prepares Federal and State Medical Boards reports; tracks State Licensing Board reporting; communicates telehealth provider requirements; manages VetPro access levels and training; assists with Joint Commission surveys, and Office of Inspector General and Government Accountability Office reviews. Coordinates with Service Chiefs and service level administrative teams for annual Committee(s) review of clinical privileges and scope of practice forms; reviews clinical privileges and scope of practices for accuracy, setting specific indicator and signature appropriations as required for VAMC compliance with Joint Commission Standards; updates clinical privilege forms to reflect procedures added or deleted. Coordinates with telehealth program team to ensure compliance. Performs as the VAMC SME on the following topics, including, but not limited to credentialing of licensed independent practitioners (LIP) and Non-LIPs; privileging and privileging related matters including focused and ongoing professional practice; adverse privileging actions; Reporting to the National Practitioner Data Bank (NPDB); and reporting to State Licensing Boards (SLB). Provides subject matter expert guidance to VAMC leadership related to credentialing, privileging, adverse privileging actions, NPDB reporting, and SLB reporting. Serves as liaison and partner with Human Resources Service programs for common program goals and issues including, but not limited to, provider onboarding, provider exit reviews and assessments, privileging actions, and guidance related to clinical performance concerns. Serves as the administrator for the TRJC. This involves managing enrollments, single queries and re-enrollments; preparing and submitting reports for adverse privileging actions; submitting federal tort claims for substandard clinical care per the OIG Counsel; ensuring that primary source verification is obtained and processed via quality control review. Serves as the administrator for the Federation of Medical Boards To qualify for this position, applicants must meet all requirements by the closing date of this announcement. Time-In-Grade Requirement:
Applicants who are current Federal employees and have held a GS grade any time in the past 52 weeks must also meet time-in-grade requirements by the closing date of this announcement. For a GS-12 position you must have served 52 weeks at the GS-11. The grade may have been in any occupation, but must have been held in the Federal service. An SF-50 that shows your time-in-grade eligibility must be submitted with your application materials. If the most recent SF-50 has an effective date within the past year, it may not clearly demonstrate you possess one-year time-in-grade, as required by the announcement. In this instance, you must provide an additional SF-50 that clearly demonstrates one-year time-in-grade. You may qualify based on your experience as described below:
Specialized
Experience:
You must have one year of specialized experience equivalent to at least the next lower grade (GS-11) in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include, but are not limited to:
Experience working in a Medical Staff Credentialing Office Credentialing and Privileging experience (for both licensed independent practitioners as well as all other dependent practitioners). Experience providing direct technical and administrative supervision to employees (tasks may include:
sets and adjusts short and long-term priorities; assesses staffing needs; plans work to be accomplished; ensures positions are appropriately manned to cover all program functions, etc.). Experience providing consulting and guidance to local leadership and Credentialing and Privileging employees on all matters pertaining to the facility's Credentialing and Privileging program. Knowledge and skill in applying analytical and evaluative methods and techniques to issues or studies concerning the efficiency and effectiveness of the facility's medical staff functions and C&P Program operations. Knowledge of pertinent laws, regulations, policies and precedents; accreditation standards and guidelines, including, but not limited to:
TJC, VHA Handbooks, Directives, Memos, and Notices; VetPro Policies/Standard Operating Procedures; and local medical center policies related to the principles, practices and program goals of the C&P program. Knowledge of the principles, provisions and practices of credentialing and accreditation and regulatory agencies such as TJC, Office of Inspector General/Combined Assessment Program (OIG/CAP) and Government Accountability Office (GAO). Knowledge and skill in Staffing regulations/requirements for health care practitioners for compliance with a range of National and Local Handbooks, Directives, MOUs, Policies, Medical Bylaws, etc.; internal and external regulatory and accrediting agencies such as TJC, CARF, URAC, and NPDB Experience working within the VetPro software (this includes:
expertise in utilization of the VetPro credentialing system including knowledge of the credentialing and privileging process, documentation of primary source verifications, and how to audit credentialing files and reporting functions). Knowledge of all VetPro policies including, but not limited to, VetPro Data Integrity, Current Appointments and Sharing Files, Facility Security Awareness and Training, and Facility Level Access control. Knowledge of medical specialties, medical terminology, and design and implementation of best practices for criteria based privileging systems for granting of clinical privileges and/or reduction and/or revocation of clinical privileges. Experience related to credentialing, privileging, adverse privileging actions, NPDB reporting, and SLB reporting. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religions; spiritual; community; student; social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience. Note:
A full year of work is considered to be 35-40 hours of work per week. Part-time experience will be credited on the basis of time actually spent in appropriate activities. Applicants wishing to receive credit for such experience must indicate clearly the nature of their duties and responsibilities in each position and the number of hours a week spent in such employment. Physical Requirements:
The work is mostly sedentary. Occasionally, light physical effort may be required, such as that involved with walking, stair climbing, and carrying of light office items. Work Environment:
The work is performed in an office setting which requires normal safety precautions typical for offices and meeting rooms. The work area is adequately lighted, heated, and ventilated. The work may require travel. For more information on these qualification standards, please visit the United States Office of Personnel Management's website at https:
//www.opm.gov/policy-data-oversight/classification-qualifications/general-schedule-qualification-standards/.
- Department:
0671 Health System Specialist - Salary Range:
$79,764 to $103,698 per year
Estimated Salary: $20 to $28 per hour based on qualifications.
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