New Hire Application Template by rfo55893


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									                                                                                                                     New Hire Name:
                                                                                                                     Hire Date:

 The three columns below show checklists for concurrent processes, of which Credentialing takes the longest (and is applicable only to clinical faculty). This combined
                         checklist must be used in conjunction with the individual Process Outlines, which are more complete and detailed .

                                                                                                                       UPH & Other CREDENTIALING/PRIVILEGING
               UA HIRING/APPOINTMENT                                         COM TITLE APPROVAL
                                                                                                                            (Applies only to Clinical Faculty)

                                                                                                                   ___ 1. Fill out New Physician Provider Data Form
___ 1. Make sure CANDIDATE has applied for position            ___ 1. Request letters of recommendation supporting (NPPDF) and submit to UPH with CV to initiate
on-line in Career Track.                                       faculty appointment .                               Credentialing process; form to Nora Alabado if UMC
                                                                                                                   privileges required.
___ 2. Indicate “Offer Accepted” in Career Track to                                                                ___ 2. Forward UPH Credentialing/privileging
                                                        ___ 2. Make sure have CV with necessary content.
initiate Background Check                                                                                          application packet to NEW HIRE.
___ 3. Send Pre-letter of offer (following Letter of                                                               ___ 3. Carefully check completed Credentialing /
Negotiation template) so NEW HIRE has something in                                                                 Privileging applications and documents when
                                                        ___ 3. Create Mentoring Plan if junior clinical suffix- or
writing, even though not legally binding--OR otherwise                                                             received, follow up if necessary with NEW HIRE, and
                                                        tenure-track appointment.
communicate with out-of-town hire re UA moving policies                                                            deliver to UPH. Advise if Temp. Cred. desired (for
and resources.                                                                                                     rush hire).
___ 4. Send New Employee Packet to NEW HIRE,                   ___ 4. When everything available and complete,    4. Forward to UPH the Credentialing Checklist and
including I-9 form and instructions for completing it with a   assemble NEW HIRE’s Title Approval Packet per     items listed below as they become available: ___
notary (if desired, to facilitate hiring process ahead of      COM Cover Sheet instructions and have considered  Proof of Fac Title; ___ C.V. month/yr; ___ Dept Offer
start date so can get EID early).                              by Dept P&T Committee and Dept Head.              Ltr; ___ 2 Ltrs Recom; ___ AZ license; ___ DEA
                                                                                                                 Certificate; ___ Board Certification(s); ___UMC Priv.,
___ 5. Draft Letter of Offer using COM template,
                                                            ___ 5. Forward original and appropriate number of    if applicable; ___ UPHK priv, if applicable; ___ email
complete Hiring Form, get Career Track application
                                                            copies of NEW HIRE’s Title Approval Packet including draft UPH contract to San Harrison as Word
signed by candidate, and forward all to Faculty Affairs for
                                                            Cover Sheet to COM Faculty Affairs for approval.     attachment.
approval and routing.
___ 6. Forward New Employee Packet to Faculty Affairs                                                            ___ 5. When receive notice from UPH that
when complete (must include I-9 form), ideally with                                                              Credentialing process completed (or Temp Cred
                                                            ___ 6. Keep NEW HIRE informed of progress through
Hiring Form and draft Letter of Offer above. FA must                                                             granted) and Delineation Form(s) arrive, have signed
                                                            appointment process.
have completed I-9 no later than start date + 2 days to                                                          by appropriate dept authority and return to UPH or
comply with E-notify.                                                                                            UMC, as appropriate.
                                                                                                                 ___ 6. When receive Formal UPH Member Practice
___ 7. When receive notice that Faculty title has been
                                                            ___ 7. For clinical faculty only: Send FAMOUS        Agreement (or Contract for Professional Services if
approved by COM (or Vice Provost, if tenure-track
                                                            Questionnaire to NEW HIRE and forward to Melanie     Faculty will be less than .50 FTE) from UPH, have
appointment), finalize and send Letter of Offer to NEW
                                                            when returned (though may be done after hire).       both copies signed by Dept Head and NEW HIRE and
HIRE & distribute when received.
                                                                                                                 return to UPH for their signature.
                                                                                                                 ___ 7. Faculty must provide UPH Administration with
___ 8. When receive turnaround PAF/PCF from
                                                                                                                 copy of Social Security card (even if wasn't used for I-
Systems, inform new Faculty of EID so can get CatCard
                                                                                                                 9 form), get UPH On-line Compliance packet &
and NetID. Follow through w/Post-PSOS process outline.
                                                                                                                 complete it ASAP.

                                                                                                                         9ee4378f-f790-4f88-ad89-f07d9e939977.xls, 1/16/08

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