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Learn MoreMedical Staff Credentialing Professionals have a myriad of responsibilities, from processing applications and verifying credentials, to managing clinical privileging, overseeing the approval process, and ensuring continuous performance improvement. As this is a profession that is consistently growing, we thought it would be beneficial to review a day in the life of a Medical Staff Credentialing Professional. Let’s dive in!
Here at HealthStream, we work with Medical Staff Credentialing Professionals representing different organizations, including hospitals, Credential Verification Organizations (CVOs), and Managed Care Organizations (MCOs). Each professional manages varying credentialing requirements depending on the type of organization they work for.
HOSPITAL | CVO | MCO |
---|---|---|
A hospital’s operational structure depends on its size as well as the type of hospital it is, like a pediatric hospital versus one that provides acute care. Generally speaking, credentialing in hospitals is impacted by a variety of factors, including:
| The credentialing process for a CVO is influenced by its contracts, policies, and procedures; federal and state laws; and regulations and accreditation standards. The most common accrediting bodies governing CVOs are: | MCO is an industry term used to collectively describe commercial third-party payers, healthcare networks, and health plans. Their credentialing processes are influenced by:
|
Regardless of the type of organization that a Medical Staff Credentialing Professional works for, they have several key responsibilities. Their big, general focus is on processing applications and verifying credentials.
After the application is complete, the department chair or medical director (depending on the organization: hospital, CVO, or MCO) reviews the application and makes a recommendation. It’s common for hospital staff to use a credentials committee for evaluations. This committee reviews the application and any supporting documents, along with the chairperson’s/medical director’s recommendation, and uses all that information to make their own recommendation to the medical executive committee (MEC).
In smaller hospital settings, or non-departmentalized hospitals, the application is usually presented directly to the MEC. The MEC then presents its final recommendation to the board, and the board makes the final decision. It’s important to note that though MCOs do not grant privileges, they do determine the applicant’s eligibility for membership/participation, and process requests for privileges to ensure compliance with regulatory standards.
The work done by Medical Staff Credentialing Professionals can be complicated and time-consuming. When tasks require so much diligence, it’s helpful to have tools in place to help keep one organized and on-target. HealthStream Credentialing solutions can simplify the process through automation. CredentialStream®, for example, provides the most comprehensive provider lifecycle management solution available. With CredentialStream, Medical Staff Credentialing Professionals can use a single solution to manage initial and re-credentialing, enrollment, onboarding, expirables management, privileging, evaluation, network management, and much more. Request a demo today, and start improving patient care on your terms.
HealthStream’s learning management system and healthcare training solutions support medical training initiatives and allow for the best patient care.
View All Learning & PerformanceHealthStream offers performance learning management solutions to help develop your healthcare staff into leaders and reduce turnover.
View All ProductsHealthStream works with healthcare organizations to create engaging and high-quality training videos for your staff and management.
View All ProductsImprove care quality and save money by making informed decisions about your healthcare facility and staff with HealthStream's reporting analytics solution.
View All ProductsHealthStream's proven methods for the improvement and overall engagement of your healthcare staff foster a positive workplace and increase retention rates.
View All ProductsWhen you enact HealthStream's quality compliance solutions, you can do so with the confidence your healthcare organization will meet all standards of care.
View All Quality & ComplianceBe confident in your staff’s ability to reduce risk by providing compliance training that changes behavior.
View All ProductsDevelop next-level people for next-level care by prioritizing quality and safety improvements.
View All ProductsEstablish a culture of belonging with education supporting DEI, wellness, engagement, and leadership development.
View All ProductsUtilize patient access solutions and advanced reimbursement solutions to manage clinical denials and improve your organization’s reimbursement strategy.
View All ReimbursementExpand the decision-making skills and effectiveness of your healthcare workforce with HealthStream's clinical development programs and services.
View All Clinical DevelopmentLearn about our advanced resuscitation training solutions. Our solutions are designed to help improve patient outcomes.
View All ProductsOur competency development solutions personalize learning for clinicians to bridge the gap between theory and practice for your nurse residents.
View All ProductsEnhance maternal & child nursing care with solutions focused on improving the quality of care for mothers, infants, and children.
View All ProductsAddress staffing orientation challenges to easily achieve and maintain certification with our emergency and acute care training solutions.
View All ProductsAs a premier provider of healthcare education, we are committed to promoting safer, more successful surgical and sedation outcomes for each and every patient.
View All ProductsOur solutions are designed to cater to the needs of patients, healthcare professionals, and organizations dealing with illnesses or chronic conditions.
View All ProductsOnline clinical placement software allows schools, healthcare organizations, and students to seamlessly manage clinical and nursing rotations.
View All ProductsComprehensive, industry-leading provider onboarding and credentialing software that validates health outcomes and supports provider assessment.
View All CredentialingOur affordable CVO credentialing services establish patient safety by enabling primary source verification for your healthcare organization.
View All ProductsIntegrate with Epic to validate and add new providers directly to your provider master file.
View All ProductsMake sure your healthcare staff can schedule out appointments and work schedules with ease using HealthStream's line of software solutions.
View All SchedulingHealthcare workforce management is essential. We provide advanced scheduling solutions for organizations to solve issues such as nurse retention
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