UPMC Physician Services – Senior Director, Provider Credentialing Active Placements

UPMC has retained Summit Talent Group to conduct a national search for a Senior Director, Provider Credentialing. This is a newly created position and the most senior system credentialing leader reporting to the Executive Administrator and overseeing a team of experienced leaders with a total of 70 FTEs. This highly visible leader will be instrumental in establishing a fully standardized, efficient CVO to support approximately 6300 physicians and 4300 APP’s across the system.

This position is responsible for the organization, management and supervision of the UPMC Credentials Verification Office (CVO) and streamlining subsequent processes of the Medical Staff Offices (MSO) and Provider Enrollment (PEC). This evolving role will interface directly with senior leadership, department heads, and external stakeholders to ensure seamless execution of credentialing processes, compliance requirements, and operational efficiency. The ideal candidate combines strong administrative expertise with a detailed understanding of credentialing operations and regulatory standards.

The Senior Director will bring a refined skill set to the role in the areas of relationship building, communication, and continuous process improvement as well as a track record of working in partnership with physicians and providers. Moreover, the incumbent will be both a change agent and a team builder, adept at engaging and mentoring the staff as well as being a champion of service excellence.

This is a tremendous opportunity for a strategy-focused medical staff services professional to build an operationally successful CVO with exceptional outcomes through high reliability and by partnering with all relevant internal and external stakeholders.

Duties & Responsibilities

• Provides leadership, direction, process improvement models & initiatives and establishes evidence based, best practice analysis to improve/establish work standards for provider credentialing.
• Accountable for the strategic direction and operational accountability within the reporting structure to ensure timely and efficient credentialing processes.
• Identify, develop, and implement short-term strategies and long-term vision for increasing efficiency of the department with a defined focus on workflow optimization.
• Establishes performance standards with which to measure effectiveness and efficiency of services.
• Ensures that the CVO contributes to and that the CVO activities are consistent with the overall mission and goals of UPMC.
• Lead the end-to-end credentialing process, including:
• Reviewing and verifying provider credentials (licenses, certifications, education, & training.)
• Coordinating with internal teams and external agencies to collect and validate documentation.
• Monitoring expiration dates and initiating renewals to prevent lapses in provider eligibility.
• Oversee integration of new provider networks & facilities.
• Act as a liaison between executives, credentialing staff, & external stakeholders ensuring clear communication and smooth operational workflow
• Lead technology initiatives, including credentialing software adoption, SharePoint migration, or other database enhancements.
• Function as the System Administrator for CredentialStream software with responsibilities including:
• Overseeing user accounts, maintaining group security, designing and submitting suggestions for functionality enhancements and requests for customizations to the development staff.
• Receiving, testing and implementing version and service upgrades, troubleshooting and resolving software issues in conjunction with the CVO ISD support staff and the CredentialStream staff.
• Designing and developing standard and specific facility reports in conjunction with the CVO ISD support team, managing the data conversion and installation of the CredentialStream software for new UPMC facilities.
• Providing internal and external demonstrations of the CredentialStream software and the UPMC processes in general and the CVO processes in particular.
• Ensures the provision of exceptional customer service to the physicians and other healthcare practitioners, the Medical Staff credentialing offices and the Managed Care Organization credentialing offices.
• Maintain, update and organize credential files and databases to ensure accuracy and compliance with federal, state, and organizational regulations.
• Monitors and assures compliance with regulatory and accrediting body standards, rules and regulations including, but not limited to, the Pennsylvania Department of Health, The Joint Commission (TJC), the American Osteopathic Association (AOA) and the National Committee for Quality Assurance (NCQA.
• Facilitate and organize committee and board meetings for credentialing review, including agenda preparation, meeting logistics, and accurate minute-taking.
• Maintain strict confidentiality of sensitive provider and organizational information, adhering to GDPR, HIPAA, and other relevant data protection standards.
• Manage projects to provide new software functionality or software applications to the users including enhancing the software to meet the needs of the users, coordinating installation, facilitating testing and providing training to staff and users as necessary.
• Assist with special projects and continuous improvement initiatives to optimize credentialing policies and procedures.

Qualifications

• Bachelor’s degree in business administration, Healthcare Administration, or related field required.
• Minimum of 5 years of progressive management experience in executive administrative in support of medical staff services & provider credentialing.
• Certified Professional Medical Services Management (CPMSM) required; additional certification in Certified Provider Credentialing Specialist (CPCS) is preferred.
• Previous Medical Staff credentialing experience required.
• Previous project development and implementation experience is required.
• Demonstrated experience working closely with senior executives and cross-functional teams.
• Knowledge of and demonstration of successful compliance with regulatory and accrediting body standards, rules and regulations.
• Detail oriented person with excellent communication and interpersonal skills.
• Strong organizational, multitasking, and time-management skills with meticulous attention to detail.
• Able to work independently with accountability for work performed.
• Excellent work ethic.
• Commitment to professional growth and continuous process improvement