Job Description
Job Description
East Hawaii Medical Group, an affiliate of the 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 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 250 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.
Essential Job Functions:
Conducts, participates in, and maintains credentialing, privileging and payor enrollment, document management, 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 applicant’s initial eligibility for membership and participation.
Participates in and oversees highly confidential peer-to-peer review meetings and oversees its process.
Administers and recommends software 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.
Oversees all communications and reporting from the Medical Staff Services Department, including informational newsletters, educational documents, memo.
Recognizes, investigates, and validates discrepancies and adverse information obtained.
Develops and cultivates working relationships with key stakeholders, both internal and external, to ensure appropriate awareness of key issues and decision-making.
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.
Maintains provider information in CAQH and other payor portals, ensuring data accuracy and completeness.
Manages Medical Staff Services department, including performance management, budgeting and day-to-day supervisor.
Other duties as assigned by management.
Knowledge Skills and Abilities:
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.
Demonstrated knowledge and understanding of concepts, key functions, terminology, and work products of risk management, finance, clinical competence evaluation, and management theories.
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.
Certification: Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certifications are required within 12 months of employment.
Updated 5/23/2025
Company Description
East Hawaii Medical Group is the East Hawaii Region's diverse provider group of over 100 physicians and advanced practice providers, representing various specialties in our hospitals and outpatient clinics. Our group is also responsible for managing the Hawaii Island Family Medicine Residency program that trains new family medicine physicians.
Benefits
Medical, dental and vision coverage for employee and your dependents
20 days (160 hours) Paid Time Off (PTO)
13 paid holidays each year (104 hours); 14 (112 hours) during election years
Eligibility to participate in 401(K) with match after three months of service
* Rates listed for paid holidays and PTO days are for 1.0 Full Time Equivalent (FTE) positions assigned to 8 hour shifts. Accruals for these benefits are otherwise prorated based on FTE.
Benefits
Relocation Assistance is available for this position.
Benefits
#IND
About Hilo & The Big Island
Hilo is located on the east side of the island of Hawaii, and has a quaint, old-Hawaii, small town atmosphere. Our island offers amazing rainforests, waterfalls and beaches. The hospital staff is community-oriented and strive to provide competent and compassionate care to every patient that enters our doors. The area is home to the Hawaii Community College, University of Hawaii, Hawaii Volcanoes National Park, excellent schools and convenient shopping.
Pre-Employment Assessments for External Candidates
As part of the recruiting process for this position, external applicants (job applicants NOT employed by HHSC’s East Hawaii Region) are required to complete pre-employment assessments shortly after application submission. If you are not an employee of the East Hawaii Region of HHSC, you will receive an email containing assessment instructions. We ask that you complete the assessments within two days of receipt of the request.
Pre-Employment Health Requirements
Offers of employment will be contingent on successfully passing a pre-employment examination, which includes a drug screen and other regulatory medical requirements such as, but not limited to, a tuberculosis (TB) screen. The cost for drug screening and blood draw for QuantiFERON and Titers, shall be borne by the Hawaii Health Systems Corporation.
EHMG-Equal Opportunity Employer
The East Hawaii Medical Group is a drug free workplace and an Equal Opportunity Employer.
Job Tags
Holiday work, Full time, Relocation package, Shift work,