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Job Summary

The Director of Credentialing for the Medical Group possesses primary responsibility for leading and managing operational requirements of the Credentialing Department in support of the medical group as well as the health care system. The Director will effectively lead and serve as the subject matter expert on all credentialing and privilege processes for medical providers and allied health professionals ensuring consistency, accuracy and compliance with established protocols, accrediting and regulatory agencies. The Director of Credentialing coordinates and collaborates with RWJBH business leaders and colleagues on day-to-day operations as it relates to credentialing.

Essential Functions

  • Develops, implements, and maintains credentialing processes and procedures to meet the needs of practices, hospitals, payers, the market, state regulations and NCQA, Medicare/Medicaid, delegated credentialing and any other credentialing parties.
  • Ensures ongoing compliance with state regulatory, legislative, NCQA, Medicare/Medicaid, Joint Commission, payer credentialing, and accrediting body requirements or laws.
  • Directs and coordinates all credentialing activities for department staff, related committees (Credentialing and Appeal Committees), and third party credentialing provider (symplr). Ensures consistent, accurate, and timely execution of credentialing processes and information.
  • Represents the Credentialing Department at medical group, system, and state/regulatory meetings. Partners with business leaders as it relates to operations and credentialing initiatives.
  • Prepares and maintains regular department reporting and credentialing database.
  • Establishes strategic goals in alignment with corporate objectives, setting priorities and managing department performance to meet developed goals.
  • Manages and maintains department budget.
  • Completes managerial duties as it relates to staffing, scheduling, performance reviews, workflows, staff development and training.
  • Other duties or special projects as assigned.

Job Requirements

  • Bachelor’s degree required. Master s degree preferred. Appropriate experience may be substituted for education requirements.
  • Minimum 5 years of credentialing experience to include at least 8 years management or supervisory experience in a credentialing setting required.
  • Professional Medical Services Management Certification (CPMSM) or Professional Credentialing Specialist Certification (CPCS) preferred; or the ability to obtain certification(s) within one year of employment.
  • Knowledge of credentialing software (symplr ) preferred.

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

RWJBarnabas Health is the most comprehensive health care delivery system in New Jersey, with a service area covering five million people. The system includes eleven acute care hospitals Clara Maass Medical Center in Belleville, Community Medical Center in Toms River, Jersey City Medical Center in Jersey City, Monmouth Medical Center in Long Branch, Monmouth Medical Center Southern Campus in Lakewood, Newark Beth Israel Medical Center in Newark, RWJUH- New Brunswick, RWJUH- Somerset in Somerville, RWJUH- Hamilton, RWJUH- Rahway and Saint Barnabas Medical Center in Livingston; three acute care children s hospitals and a leading pediatric rehabilitation hospital (Children s Specialized Hospital), a freestanding 100-bed behavioral health center, trauma centers, a satellite emergency department, ambulatory care centers, geriatric centers, the state s largest behavioral health network, comprehensive home care and hospice programs, fitness and wellness centers, retail pharmacy services, a medical group, multi-site imaging centers and an accountable care organization.

RWJBarnabas Health Medical Group is a multispecialty group practice comprised of highly trained and experienced world class primary and specialty care physicians. RWJBarnabas Health Medical Group physicians provide compassionate and innovative cutting-edge care for people at every stage of life at easily accessible facilities conveniently located throughout New Jersey. Backed by the vast continuum of resources of RWJBarnabas Health, the largest not-for-profit integrated health care delivery system in New Jersey and one of the largest in the nation, our dedicated physicians and expertly trained supporting staff continuously strive for clinical excellence.

We offer a great work environment, competitive rates and excellent benefits, including:

  • Medical/Dental/Vision plans
  • 401 (k)
  • PTO
  • Short & Long Term Disability
  • Basic Life & Accidental Death Insurance
  • Tuition Reimbursement
  • Health Care/Dependent Care Flexible Spending Accounts