Job Summary:

East Hawaii Region of Hawaii Health Systems Corporation is seeking a dynamic and experienced Regional Medical Staff Services Administrator to lead and manage the operations of the Medical Staff Services department. This department head position involves overseeing the operational function of the Medical Staff Department including credentialing, payor enrollment, peer review, and ensuring compliance with all relevant regulations and standards. The ideal candidate will have a strong background in medical staff services best practices and initiatives that enhance the overall provider experience.

The Medical Staff Services Department supports a medical staff of approximately 600 physicians, nurse practitioners and physician assistants across 33 specialties who provide services at Hilo Benioff Medical Center, Honoka'a Hospital, Ka'u Hospital and Yukio Okutsu State Veterans Home. This is a newly established position that will report to the Regional Chief Human Resources Officer and the Regional Chief Executive Physician.

Location: Must be on-site when hired to meet operational requirements.

Essential Job Functions:

• Provides strategic leadership and oversight in credentialing, privileging and payor enrollment, document management, OPPE and medical staff quality monitoring, policy review, quality interface of all Medical Staff, ensuring compliance with internal and external policies and legal/regulatory requirements.
• Directs all actions related to Medical Staff applicants initial eligibility for membership and participation.
• Leads the preparation, documentation, agendas, policies, and meeting packets for Medical Executive Committee meeting and serves as a key advisor by attending all meetings in person.
• Manages all incident agreement and routes them to the appropriate parties in accordance with established service level agreement (SLA).
• Facilitate and participates in highly confidential peer-to-peer review meeting, overseeing the process, and attend meetings in person.
• Evaluates, implements, and optimizes software, systems, and technical solutions to optimize credentialing, payor enrollment and related workflows.
• Develops and updates applicable governing documents including bylaws and credentialing policies that support and direct organizational best practices and ensure compliance.
• Recognizes, investigates, and validates discrepancies and adverse information obtained.
• Builds, strengthens, and maintains strategic relationships with internal and external stakeholders, including Human Resources, Employee Health, Organizational Development, Contracting, Information Technology, and Payor Enrollment, to support effective decision-making, coordinated workflows, and alignment of Medical Staff functions across the Region.
• Collaborates with physician leaders to develop and maintain a region-specific criteria-based clinical privileging system in accordance with regulatory requirements, accreditation standard, and organizational policies.
• Ensures the integrity, accuracy, and maintenance of all provider information in CAQH and other payor portals.
• Leads continuous improvement initiatives using best practices, data insights, and technology to optimize workflows and strengthen departmental capabilities.
• Provides strategic direction and oversight of Medical Staff Services communication, including informational newsletters, educational documents, memo.
• Manages Medical Staff Services department, including performance management, budgeting and day-to-day supervisor.
• Other duties as assigned by management.

Qualifications:

Experience:

• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certifications are required within 12 months of employment.

Experience:

• A minimum of 10 years of experience in the medical services field, with at least 5 years in leadership (preferably director level).

Education: 

• Bachelor’s degree preferred.

Skills

• Ability to maintain a high level of confidentiality.
• Ability to analyze and interpret complex data with the end goal of presenting and creating tactical plans. Organizes information and data to identify and explain trends, problems and their causes.
• Ability to organize work, create priorities, strategic plans, and develop SMART goals.
• Excellent communication skills, both written and oral.
• Excellent interpersonal skills. Exhibits confidence and professional diplomacy while identifying, organizing, facilitating, and sustaining mutually-beneficial partnerships and alliances with people at all levels of the organization.
• Ability to gain cooperation and support, resolve differences, and reach compromises with others.
• Working knowledge and expertise in MDStaff and MDStat.
• Demonstrated knowledge and understanding of concepts, key functions, terminology, and work products of risk management, finance, clinical competence evaluation, and management theories.

About East Hawaii Medical Group

East Hawaii Medical Group (EHMG), an affiliate of the East Hawaii Region of Hawaii Health Systems Corporation, is dedicated to advancing high-quality, patient-centered care throughout East Hawaii. Serving Hilo Benioff Medical Center, Honoka?a Hospital, Ka'u Hospital, and the Yukio Okutsu State Veterans Home, EHMG ensures that providers are equipped to deliver exceptional care to our island communities. Established with our mission to improve the health and well-being of East Hawaii, EHMG's administrative teams play a critical role in strengthening provider operations, optimizing workflows, and enabling sustainable, high-quality patient care across the region.

Connections working at East Hawaii Medical Group