Ophthalmology

**NEW SITE/JO**

Assigned Recruiter: M. Guzman

Client Name & Location: WellStar Kennestone Hospital

677 Church St.

Marietta, GA 30060

Hospital Details

:

Hospital Bed Size: 662Trauma Level: Level II

Reason For Coverage:

Dates & Required Availability:

9/09-9/12

9/23-9/26

9/30-10/4

10/21-10/25

10/28-11/01

11/8 (Friday Only)

12/02-12/06

12/23-12/27

12/30-1/03

1/06-1/10

Shift & Call Details : Monday-Friday

8a-4:30p (40 hours per week)

Credentialing Timeframe:

90 days

Job Details :

Setting :

100% InpatientPatients Per Day : AVG. 20 (7 new consults)Required Procedures :100% Adult, Colonoscopy, EGDEMR : EPICAPP:

NoClient Requirements:

Must be BC in GICOVID Vax status and Experience with EPIC

please add to presentation if they can test out of EPIC.Travel Accommodations : client will pay all travel booked through DLT

Additional Details:

Pay & Bill Rates Pay $400/Hour Bill $580/Hour

= 30% or $2059 GM per day (*New Bill confirmed with client)Name Clear Process:

Will send name clear to WMG Locums Please include DOB and NPI number with name clear. Please have presentation ready to present with COVID Vax status and EPIC exp.Sub Process:

Once clear, will present to Lauren Gobble (PM-Dione Riovers), she will phone screen and accept/declineUnique Client Requirements:

DEA Required In State While Privileging,Client History/Success: Currently have 4 locums working GI with WellStar (other-site) One went perm and they moved her to another location.List ALL locations where locum needs privileges: Cobb, Douglas, Paulding, KennestoneCOST CENTER:

5049638

Please prepare your providers for these steps in the privileging process, once accepted:

CV

Please confirm the attached CV is accurate and represents ALL of your work history including locum tenens agency names.

Online Application

Wellstar uses an Online Application.

You will receive an email directly and will create a username/password.

Please forward me the log in details once created.

Drug Screening

Wellstar requires a drug screen upfront & it must occur within 1 week (all costs covered). Please complete and return the attached “Chain of Custody” forms.

Once received, I will send you the drug screen location & the necessary forms.

Wellstar HR

Forms

These forms will be sent via Docusign and prompt completion is appreciated.

Supporting Documents

Below is a list of commonly requested supporting documents during the credentialing process. You can disregard any documents that do not apply. Kindly start gathering documents & send either via email or via fax (267-350-9104)

Training Diplomas

(Med School, ECFMG, internship, Residency, Fellowship)Board CertificatesCPR CertificatesState Medical License(s)

(please send all active licenses)Federal DEADriver’s License or Passport

(color copy)Color Photo

(for badge)CMEs

(past 2 years)CAQH and NPI

(usernames/passwords)Immunization Records

(TB, Flu, MMR, Hep B are commonly requested)Malpractice Coverage

- (5 Years of History Requested)DD214 –Military Discharge form

(if applicable)Case Logs/Clinical Activity Reports

(past 2 years)- we can help obtain if needed