**NEW SITE/JO**
Assigned Recruiter: M. Guzman
Client Name & Location: WellStar Kennestone Hospital
677 Church St.
Marietta, GA 30060
Hospital Details:
- Hospital Bed Size: 662
- Trauma 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% Inpatient
- Patients Per Day: AVG. 20 (7 new consults)
- Required Procedures:100% Adult, Colonoscopy, EGD
- EMR: EPIC
- APP: No
- Client Requirements: Must be BC in GI
- COVID 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/decline
- Unique 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, Kennestone
- COST 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 Certificates
- CPR Certificates
- State Medical License(s) (please send all active licenses)
- Federal DEA
- Driver’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
