Credentialing is a critical part of the recruitment, selection, and hiring process in healthcare agencies throughout the nation. The U.S. Department of Health and Human Services, among other health agencies, has developed a definition of credentialing for medical purposes. This definition suggests that credentialing involves a process where the qualification of licensed or certified health care practitioners is assessed, confirmed, and verified (HRSA, 2006). Privileging is a process that results from credentialing, allowing healthcare organizations to employ and assign practitioners to provide a wide-range of services to patients (HRSA, 2006). Privileging may vary from agency to agency or organization to organization. Credentialing is a critical part of the hiring process, and ongoing employment practices for healthcare agencies (Buppert, 2002). Credentialing ensures that qualified medical professionals are licensed to perform services, and have the appropriate qualifications to perform services required by the organization (Medpro, 2014; Buppert, 2002).
The credentialing process is similar to the process of checking references, or conducting a background check in ordinary hiring. However, for medical practitioners, credentialing goes a step further, ensuring that providers are qualified and have received appropriate education that meet organizational standards (Medpro, 2014). Without the process of credentialing, healthcare organizations may increase their risk and liability when hiring practitioners to offer services to patients. Most organizations require that practitioners are credentialed first so that the health organization or agency can subsequently provide privileges for health practitioners to offer services at their centers.
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"Credentialing Purpose in Healthcare".
In the healthcare organization, there are accrediting bodies, or designated authorities that define what standards are needed for a healthcare provider to be licensed, and to practice within a certain geographic scope, and service area (MedPro, 2014). For example, a registered nurse may undergo credentialing to determine their ability to practice in a hospital or long-term setting. The credentialing process will also ensure that a nurse has the appropriate credentials if they are to specialize in an area of care, like mental health or OB/GYN. With licensing, some healthcare practitioners may have more expertise in specialized area of care. Healthcare organizations have a duty to engage health professionals by first ensuring they meet the standards an organization has developed for hiring, and then by ensuring that their providers meet the minimum state or federal regulations required to work at the designated facility and with patient populations.
Healthcare organizations do have the ability to request pre-application by health professionals, which can allow the health organization to identify candidates that do and do not meet the minimum requirements for practicing within a facility (Medpro, 2014). By establishing pre-application procedures, a healthcare organization can limit the amount of time spent on candidates that may not be fully qualified to operate within the healthcare organization. To assist with this process, healthcare organizations can address a set standard of prepared questions that ascertain a healthcare provider’s credentials (Buppert, 2002). These questions may answer whether a health provider has a restricted or unrestricted license, whether a health provider has a criminal history, what board certification a health provider has or may need to complete the job requirements, and even determine whether the health practitioner has had any disciplinary actions against them at other facilities or by professional organizations (Medpro, 2014). Engaging in this process ensures due diligence. While having disciplinary action may not disqualify a candidate entirely from consideration, a healthcare organization can prevent negligent hiring or engage a candidate in a lengthy and costly recruitment process if the candidate is not appropriate for the job function or duties. Credentialing is also helpful for identifying what health practitioners may practice in specialties, and help the organization determine and stay abreast of changing specialty requirements whether these are established by state or other institutions.
