New Hire Name:
PROSPECTIVE SALARIED FACULTY COMBINED CHECKLIST - FOR DEPT USE
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
___ 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
communicate with out-of-town hire re UA moving deliver to UPH. Advise if Temp. Cred. desired (for
policies 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 assemble NEW HIRE’s Title Approval Packet per items listed below as they become available: ___
a 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
Cover Sheet to COM Faculty Affairs for approval. attachment.
for 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
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
HIRE & distribute when received.
and 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.