Director, Medical Staff Services

Medical Staff Affairs - 208030 Winchester, Virginia Full-Time

To see if this position qualifies for a sign-on bonus, click here: Valley Health Sign-On Bonuses

Please Note: To protect our patients, our workforce and our community, Valley Health is requiring that all newly hired employees and internal transfers (current employees requesting internal transfers) must have received at least one COVID-19 vaccination dose. Newly hired Applicants (those not currently employed by Valley Health) who have been offered a position will have to provide documentation of their vaccination status at the time of their Employee Health appointment. For internal transfers, Employee Health will contact you if they have questions around your vaccination status. Valley Health has a process for applicants who have been offered a position to request an exemption or deferral for medical or religious reasons. To search for vaccine locations, visit


  • Entity: Winchester Medical Center
  • Shift: Day

Who We Are

Valley Health System is a not-for-profit network of hospitals, urgent cares, physician practices, and services. Expanding across Virginia, West Virginia, and Maryland, we are devoted to the health of all who call our 18-county area home.

A vital resource for healthcare, we are the region’s largest employer, a dependable community partner, and are at the leading edge of clinical innovations.

We are looking for passionate, innovative, and caring people who will each bring their unique skills and perspectives to our workplace.

What You Will Do:

The Director of Medical Staff Services is responsible for Credentialing/Privileging, Ongoing Professional Performance Evaluation, Focused Professional Performance Evaluation, Credentialing Verification Organization creation, Medical Staff Office and Peer Review at all acute care locations within Valley Health System.
The Director will be responsible to standardize the credentialing process across the acute care hospitals as well as create a structure for consistent, reliable OPPE/FPPE to occur at each site and to utilize meaningful data for each medical specialty. The Director will have oversight of the Medical Staff Coordinators to ensure each medical staff is provided the level of support necessary. The Director will also be integral to creating and supporting the Credentialing Verification Organization, enabling all of Valley Health to initiate a common application.
Peer Review will require maintaining confidentiality while performing analysis and review of medical records, performance improvement documents and quality profiles of physicians. The Director will ensure the Peer Review process supports the Performance Improvement initiatives and Peer Review Committee.
Essential Functions of the Position:
1. Provides staff supervision for personnel in the Acute Care Division Medical Staff Offices and the Central Verification Office (CVO) for VHS. 2. Is a subject matter expert in Focused Professional Practice Evaluation (FPPE), Ongoing Professional Practice Evaluation (OPPE) and Medical Staff Peer Review. 3. Knowledge of the Joint Commission, CMS, State License and Department of Health standards By Laws and Rules and Regulations as they relate to the Medical Staff. 4. Provides support for the Medical Staff Leadership including but not limited to, Medical Staff Executive Committee (SEC), Medical Staff meetings, Department meetings and miscellaneous ad hoc Medical Staff committees. 5. Responsible for the VHS Medical Staff Services budget and oversees the Medical Staff Office budget at each site. 6. Strong coaching, teaching and facilitation skills with demonstrated capacity for motivation, developing and leading people. Ability to educate and motivate medical staff office personnel and physician leaders to accomplish the processes that support appointment and reappointment to the Medical Staff to include privilege set development and maintenance, FPPE and OPPE. 7. Ability to analyze data. 8. Ability to use credentialing/quality software to include database administration and management. 9. Must demonstrate the ability to accurately use a computer and standard office software such as Microsoft Excel, Word, Access and Power Point and competency with data reporting systems. 10. Must be willing to occasionally travel to other VHS sites (“home base” will be WMC). 11. Knowledge of medical terminology.

What You Will Bring:


Bachelor's degree in Nursing or any health-related field required
Master's degree in Nursing or any health-related field preferred

Minimum of 5 years experience in healthcare or nursing or clinical practice
Minimum of 5 years experience in peer review or risk or quality

Certification & Licensures
CPHQ or other Quality/Safety certification

Proven ability to analyze, interpret, and display data; strong attention to detail; meticulous accuracy and thoroughness.
In depth knowledge of medical terminology
Strong organizational, analytical and problem-solving skills with the ability to work independently as well as with a team.
Demonstrated excellence in interpersonal and written communication skills required
Must demonstrate the ability to accurately use a computer and standard office software such as Microsoft excel, word, access and power point and competency with data reporting systems. Aptitude in collaborating with teams that include key stakeholders and/or leadership to reach consensus.
Ability to coordinate multiple tasks and flexibility to balance changing priorities. Ability to build relationships and foster communication among stakeholders in clinical and non-clinical settings.

What You Will Get:

- Competitive salary
- Flexible scheduling
- Health Insurance
- Paid Time Off
- Wellness Program
- Tuition Assistance
- Retirement Plan
- Life Insurance

*some benefits are subject to change due to job status

We celebrate, support, and thrive on our differences for the benefit of our employees, our patients, and the communities we serve.
We are neighbors caring for neighbors, and our goal is always to help those we serve get well, feel well, and stay well.


Criminal Background Checks
VA State Police
3rd party Background Check

FLSA Classification


Physical Demands
3 A Administration