Network Medical Management Jobs in California (NOW HIRING)

Job Description:

The Senior Director, Network Medical Affairs and Governance is accountable for the overall administrative planning and coordination of the staffing, fiscal and material resources. Oversees the establishment of systems to maintain provider data, monitor credentialing processes, complaint resolution, and regulatory compliance.

Ensures effective integration, alignment and operations of the medical staff services programs across the Network business unit, in compliance with applicable State and Federal laws. Develops and leads strategies for developing improvements and efficiencies in Network practices and Community Hospitals Division through reviewing and redesigning of workflows and operational systems.  Oversees the Network business unit medical staff affairs and governance and supports harmonization of UCSF Health strategies with partnerships, affiliates and joint ventures at all levels of complexity within the Network, mitigating risk and focusing on alignment. Strategizes, leads and directs initiatives within the medical staff team of the UCSF Health system and Network business unit to provide overall continuity and oversight.  Supports UCSF Health system and Strategy efforts in building relationships with the Network and supports tactics to increase market for the UCSF Health footprint. Develops pathways for UCSF Health to maintain governance oversight over Network and Community Hospitals Division.  

Department Overview:

The Office of Medical Affairs and Governance (OMAG) is an enterprise-wide office responsible for oversight of clinicians and providers who are credentialed, privileged, and/or affiliated with UCSF Health and able to practice at any of its hospitals, clinics, ambulatory surgery centers, and affiliated sites.  The office's central units manage the credentialing and privileging of providers, health plan payer enrollment for both government and commercial plans, and the peer review program of the institution.  In addition, the health system's governance function is organized under OMAG where the team manages the various medical staff committees, management boards, and the governing body.  

Minimum Requirements:

• Bachelor's degree in related area and / or equivalent experience / training
• Certified Professional Medical Services Management (CPMSM)
• Five or more years of experience at the Manager/Director level
• Strong knowledge of external regulations, Network credentialing best practices and clinical operations to implement in an acute care setting
• Strong strategic skills to develop long range plans, and abilities to solve complex, wide reaching problems when no precedent exists
• Strong management and conflict resolution skills to effectively lead and motivate others. Successful background working with peers, patients, multidisciplinary team members, executives, assigned staff and representatives of regulatory agencies
• Strong skills in collaboration, ability to build and maintain relationships with physicians, clinical department heads and senior management
• Strong knowledge of the approaches and methods of process improvement, including planning, setting priorities, systematic performance assessment, implementation of process improvements based on such assessment, and maintaining achieved improvement
• Knowledge of organization structure, Network structure and change management skills to streamline systems and design processes to improve efficiency of operations
• Knowledge of HR and UC policies and processes
• Skills to consistently interact with all members of the organization in ways that enhance understanding, respect, cooperation and problem solving
• Ability to exercise professional judgment in handling sensitive and confidential issues with discretion. Demonstrated sensitivity to political situations and confidential issues
• Advanced ability to quickly evaluate complex issues and identify multiple options for resolution

Preferred Qualifications:

• Master's degree in related area
• Certified Provider Credentialing Specialist (CPCS)

% of timeEssential Function (Yes/No)Key Responsibilities (To be completed by Supervisor)  20% Yes Oversees the planning and organization of the network medical staff services functions. Prepares and oversees the monitoring of the department's operational and capital equipment budgets. Oversees Network medical affairs, credentialing and governance services including; acquisition and integration medical staff planning, stewardship, relationship building and repositioning of organizational culture to align with UCSF initiatives and priorities. Oversees consistent programs and processes across the Network and in alignment with the UCSF Health system.
   10%YesInterprets and enforces the functions and responsibilities of the Network medical staff governance structure. Works with clinical departments in the review / revision of rules and regulations, privileging forms and criteria, and credentialing standards. Identifies Health system alignment areas of importance to the Network and the system.  20%YesDevelops long-term strategic plans and ensures short-term plans are in place for subordinate management. Oversees the implementation and operations of affiliate Network governance, affiliate credentialing, affiliate peer review, and affiliate quality programs. Supports plans to expand presence to new regions and supports new affiliation models. 
Develops strong working relationships with Network entities, affiliate physicians, senior management, administrative leaders, and other stakeholders. Aligns long-term strategic policies, systems, and projects with impact on the Network and in harmonization with the UCSF Health system to improve Network medical staff services.
   10%YesInteracts across the Network and in alignment with the UCSF Health system to support leadership on decisions impacting key areas within the Network business unit, including business strategy and organizational growth related to Network development. Forms partnerships and aligns with stakeholders locally, regionally, and nationally.  Provides leadership on task forces and committees related to network medical staff functions and issues. Serves as a resource to both internal and external customers, including Network Medical Boards, Credentials Committees, clinical departments, physicians, regulatory agencies, medical groups, hospitals, and health plans.  10%YesAssures compliance with medical staff bylaws and other accreditation and regulatory requirements as they relate to Network medical staff governance. Manages team supporting audits to maintain accreditation and credentialing.  10%YesAccountable for the overall administrative planning and coordination of the staffing, fiscal and material resources.  10%YesOversees and directs delegated credentialing audits with regulatory agencies. Collaborates with other department heads to develop compliance policies and procedures in conformance with audit requirements. Initiates responses to corrective action plans and is accountable for complete resolution to audit recommendations.  5%YesOversees Network medical staff investigations, disciplinary actions, judicial reviews, and appeals to ensure compliance with established process.  5%YesForecasts long term resource and talent needs. Defines development and growth consistent with workforce planning. Develops core competencies, assessment plans and tools. Provides mentorship / leadership to managers and supervisors. Reviews and approves individual leadership / professional development plans, with succession planning needs in mind.  100% (To update total %, enter the amount of time in whole numbers (without the % symbol - e.g., 15, 20) then highlight the total sum (e.g., 1%) at the bottom of the column and press F9. The total sum should add up to 100%.)