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Credentialing
Specialist Checklist
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NAME
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LAST 4 OF SSN
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DATE
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I hereby certify that
ALL information I have provided to IMCS Group on this skills checklist and
all other documentation, is true and accurate. I understand and acknowledge
that any misrepresentation or omission may result in disqualification from
employment and/or immediate termination.
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Instructions: This checklist is
meant to serve as a general guideline for our client facilities as to the
level of your skills within your nursing specialty. Please use the scale
below to describe your experience/expertise in each area listed below.
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Proficiency Scale:
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1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently
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Rating Stars (Click)
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Accreditation Knowledge
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1
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2
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3
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4
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Know standards (e.g., Joint
Commission, NCQA)
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Operationalize standards
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Prepare for survey
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Participate in survey
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Develop action plans
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Rating Stars
(Click)
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Computer Literacy/Use of
Technology
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1
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2
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3
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4
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Basic
word processing
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Database Management
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Evaluate and select
software
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Write reports from software
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Make
recommendations for redesign of processes based on available technology
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Rating Stars
(Click)
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Credentials Process
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1
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2
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3
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4
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Establish
process/procedures for staff to follow
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Write policies and
procedures
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Conduct primary source
verification Prepare files
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Develop and implement
quality control system
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Develop and maintain system
for monitoring expiring credentials
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Develop and maintain system
for reappointment
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Rating Stars
(Click)
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Budget and Finance
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1
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2
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3
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4
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Develop operating budget
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Develop capital budget
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Annualize expenses
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Analyze accounting reports
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Monitor budget and adjust
operations as needed
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Rating Stars
(Click)
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Human Resources
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1
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2
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3
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4
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Write job descriptions
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Interview candidates Hire
staff
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Hire staff
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Conduct staff training
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Conduct performance
evaluations
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Perform counseling/coaching
Orient staff
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Orient staff
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Terminate staff
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Delegate tasks/assignments
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Rating Stars
(Click)
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Office Systems
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1
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2
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3
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4
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Organizational skills
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Establish filing systems
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Establish work flow
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Manage projects
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Develop project plans
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Maintain staff schedules
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Rating Stars
(Click)
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Medical Staff Services
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1
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2
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3
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4
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Prepare draft bylaws
language
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Prepare draft
policies/rules
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Research issues for medical
staff
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Meeting preparation
(agenda, notice)
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Meeting facilitation
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Document minutes of
meetings
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Understand peer review
process
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Facilitate medical staff in
peer review process
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Rating Stars
(Click)
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New Applicants
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1
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2
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3
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4
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Application sent promptly
upon your request
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Instructions for the
credentials process were accurate and thorough
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Staff answered your
questions completely
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Staff answered your
questions completely
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Staff kept you informed of
status Requests for additional information were made courteously
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Overall, my satisfaction
with the process
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Overall, my satisfaction
with the MSSD staff Medical
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Rating Stars
(Click)
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Staff Leadership
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1
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2
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3
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4
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MSSD staff are responsive
to my requests
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Documents prepared are
accurate, complete, and professional in appearance
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Staff anticipate my needs
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Staff maintains
confidentiality of sensitive information
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Overall, the staff meets my
needs
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Overall, I am satisfied
with the service provided by the department
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Rating Stars
(Click)
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Medical Staff Member
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1
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2
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3
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4
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MSSD staff are responsive
to my requests
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Staff are professional
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Staff are courteous
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Overall, I am satisfied
with the department
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Rating Stars
(Click)
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EMR
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1
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2
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3
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4
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Epic
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Cerner
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Eclipsys
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McKesson
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Meditech
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Other Computerized System
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Computerized Physician
Order Entry
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Bar Coding for Medication
Administration
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MY EXPERIENCE IS
PRIMARILY IN:
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Unit
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No. of Years
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Unit
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No. of Years
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BURN
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POST PARTUM
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CRITICAL UNIT
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LABOR & DELIVERY
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PACU
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NEWBORN NURSERY
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NEUROLOGY
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LEVEL II NICU
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TELEMETRY
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LEVEL III NICU
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MEDICAL
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PICU
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SURGICAL
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PEDIATRICS
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ONCOLOGY
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OB/GYN
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ORTHOPEDICS
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PSYCHIATRY
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OPERATING ROOM
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RRT
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EMERGENCY ROOM
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CRT
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TRAUMA CENTER
LEVEL 1
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COMMUNITY ER
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RURAL ER
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Rating Stars
(Click)
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Age Specific Competencies
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1
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2
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3
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4
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Newborn/Neonatal (birth –
30 days)
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Infant (30 days-1 year)
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Toddler (1-3 years)
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Preschool (3-5 years)
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School Age Children (5-12
years)
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Adolescent (12-17 years)
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Young Adults (18-44 years)
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Middle Adults (45-64 years)
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Older Adults (>65 years)
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