Credentialing Specialist - Registered Nurse (RN)

 
Position: Credentialing Specialist - Registered Nurse (RN)

Job ID: 155413

Location: US-TX-Houston

Department: MSO-Operations

Talent Area: Registered Nurse

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a-5p

About Texas Children's Hospital

Texas Children’s Pediatrics is the nation’s largest primary pediatric care network with more than 200 physicians dedicated to the health care needs of infants to teenagers in over50 locations throughout the greater Houston area. As part of our goal to build a community of healthy children, Texas Children's Pediatrics Community Cares Program provides trusted, high-quality pediatric medical services for children who otherwise would seek care from emergency centers or possibly go without care or treatment due to low family incomes and/or lack of health insurance.   To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.   Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

Summary:

We are searching for a Credentialing Specialist RN -- someone who works well in a fast-paced setting. In this position, you will process all provider applications in accordance with organizational credentialing policies and procedures and to comply with NCQA and JCAHO standards. This role coordinates medical record reviews and assists with site audits as part of the credentialing process, prepares applications for committee review, assists the Quality Department with improvement projects and collects and verifies BLS/PALS certifications.

Think you’ve got what it takes?



Responsibilities :

  • Produce and distribute provider specific letters and packets
  • Work in collaboration with the Credentials Verification Organization (CVO) to verify provider credentials
  • Coordinate, perform and evaluate medical record reviews as part of initial credentialing, re-credentialing and as requested by the Credentials committee
  • Send out, as needed, requests for Board certificates, Malpractice face sheets, collaborative agreements and other assorted information
  • Maintain up-to-date knowledge of NCQA and Payer requirements and policy changes and ensures that TCP/TCUC’s credentialing policies reflect and comply to requirements and changes
  • Collect and/or verify BLS/PALS certification for all initial and re-credentialing providers
  • Collaborate with the central business office, the compliance department, the contracting department risk management, human resources, medical staff services and other credentialing stakeholders


Qualifications:

  • One of the following educational credentials are required: Bachelor’s degree in nursing or Associate’s degree in nursing with acceptance or current enrollment in a BSN program and signed agreement (see comments below) or an associate’s degree in a related field accepted by the Texas Board of Nursing for the purposes of obtaining and maintaining an RN license, or Technical diploma in nursing with acceptance or current enrollment in a BSN program and signed agreement or Must be currently enrolled in a nursing bridge program working toward an MSN. Verified BSN-equivalency or a signed agreement is required
  • RN license from the Texas Board of Nursing or Nursing Licensure Compact required
  • 5 years clinical experience required


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