Job Details

Job Summary

The Director of the Vandalia Provider Hospital Organization (PHO) is responsible for the strategic operations of the PHO. This role oversees performance improvement, payer relationships, and compliance with regulatory requirements and accreditation standards. This role ensures operational efficiency, and leads a team dedicated to maintaining high-quality services. The Director works closely with hospital leadership, affiliated providers, and payers to advance strategic initiatives and support the organization's mission of delivering high-quality, cost-effective care.

Responsibilities

Strategic Leadership & Operations:
• Develop and implement policies, procedures, and best practices to streamline payer credentialing and primary source verification processes.
• Ensure compliance with NCQA, URAC, Joint Commission, CMS, DNV and other relevant accreditation and regulatory requirements.
• Oversee technology and data management systems to maintain secure and efficient credentialing and administrative support operations.
• Establish and monitor key performance indicators (KPIs) to enhance efficiency, accuracy, and turnaround times.
• Lead initiatives to improve automation and innovation in the credentialing and administrative support process.

Regulatory Compliance & Quality Assurance:
• Maintain knowledge of federal, state, and accreditation requirements affecting credentialing.
• Ensure timely and accurate credentialing of providers, minimizing risks related to non-compliance.
• Conduct audits and quality reviews to assess adherence to internal policies and industry standards.
• Serve as the primary liaison for regulatory and accreditation audits, responding to inquiries and implementing corrective actions as needed.

Team Leadership & Development:
• Lead, mentor, and develop a team of professionals.
• Foster a culture of continuous learning, professional development, and accountability.
• Manage department staffing, training, and performance evaluations to ensure a high-performing team.

Stakeholder & Client Relations:
• Collaborate with internal departments such as, Medical Staff Services, Revenue Cycle, Vandalia Health Network, Compliance, and other departments to align processes with organizational goals.
• Serve as a point of contact for external clients, including health plans, hospitals, and provider groups.
• Develop and maintain strong relationships with key stakeholders to enhance service delivery and customer satisfaction.

Financial & Business Management:
• Develop and manage departmental processes, ensuring cost-effective operations.
• Identify opportunities for revenue growth, service expansion, and process improvement.
• Analyze financial data provided from Revenue Cycle areas to support strategic decision-making.

Knowledge, Skills & Abilities

Patient Group Knowledge (Only applies to positions with direct patient contact)

The employee must possess/obtain (by the end of the orientation period) and demonstrate the knowledge and skills necessary to provide developmentally appropriate assessment, treatment or care as defined by the department's identified patient ages. Specifically the employee must be able to demonstrate competency in: 1) ability to obtain and interpret information in terms of patient needs; 2) knowledge of growth and development; and 3) understanding of the range of treatment needed by the patients.

Competency Statement

Must demonstrate competency through an initial orientation and ongoing competency validation to independently perform tasks and additional duties as specified in the job description and the unit/department specific competency checklist.

Common Duties and Responsibilities
(Essential duties common to all positions)

1. Maintain and document all applicable required education.
2. Demonstrate positive customer service and co-worker relations.
3. Comply with the company's attendance policy.
4. Participate in the continuous, quality improvement activities of the department and institution.
5. Perform work in a cost effective manner.
6. Perform work in accordance with all departmental pay practices and scheduling policies, including but not limited to, overtime, various shift work, and on-call situations.
7. Perform work in alignment with the overall mission and strategic plan of the organization.
8. Follow organizational and departmental policies and procedures, as applicable.
9. Perform related duties as assigned.

Education
• Bachelor's Degree (Required) Education: Bachelor's degree in healthcare administration, business, or a related field (master's preferred).Experience: Minimum of 7-10 years of progressive leadership experience in a healthcare setting, Insurance Payer or PHO/ACO/CVO operations, accreditation processes, and regulatory compliance.Skills & Competencies:• Strong understanding of provider networks, managed care contracting.• Proven ability to lead multidisciplinary teams and foster provider relationships.• Excellent leadership, communication, critical thinking, and analytical skills.• Experience with data analytics, population health tools, and EHR systems is a plus.• Strong knowledge of NCQA, URAC, DNV Joint Commission, CMS, and other credentialing-related regulations.• Ability to manage multiple priorities, deadlines, and stakeholder expectations.• Proficiency in credentialing software and healthcare technology systems.

Credentials
• No Certification, Competency or License Required

Work Schedule: Days

Status: Full Time Regular 1.0

Location: Northgate-400 Association Dr.

Location of Job: US:WV:Charleston

Talent Acquisition Specialist: Anita J. Ferguson ...@vandaliahealth.org