Quality Compliance and Value Based Contracting Optimization Manager

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Job description

Responsibilities:
Position Summary: The Quality Compliance and Value Based Contracting Optimization Manager works in collaboration with organizational executives, service line leaders, operational managers, and payor-relations teams, in the analysis of clinical data to synthesize clinical and population-based approaches to disease prevention and health promotion. Interface and develop relationships with targeted Payors and key employees for the purposes of implementation of Value Based contracting and HEDIS and/or similar program compliance elements. Manage and facilitate the access, clinical synthesis, distribution, and analysis of internal and comparative data in support of system strategic, operational, and quality projects. Analyze, study, or suggest implementation procedures for improvement; work with program specialists as appropriate, to develop more viable implementation procedures and coordinate with appropriate staff to make needed changes. Consult on, monitor, and measure the outcome of various population and disease-based, quality, and payor-related programs. Execute and collaborate with team members and leaders on strategies for improvement in care coordination, bundled payments, payer incentive programs, and other integration strategies. The Quality Compliance and Value Based Contracting Optimization Manager maintains individual competence, performs competency and annual performance evaluations of assigned employee partners, and provides consultation in area of expertise to management, staff, and other disciplines. The Quality Compliance and Value Based Contracting Optimization Manager will assist Director with scheduling and payroll function for department staff.

QUALIFICATIONS

Experience:

Minimum of two years of management experience including ongoing review, assessment and education of staff and policy & procedure management.

Expert level knowledge of payor derived value based contracting metrics and structures

Minimum of two years of demonstrated experience in translating evidence-based guidelines from standards bodies into clinical practice and knowledge of publicly reported quality evaluation programs.

Development and production of reports and documentation for review by various levels of both clinical and administrative management

Demonstrated ability to explain evidenced-based care concepts to clinical and administrative management

Track record of creating and managing collaborative multi-disciplinary teams of health professionals.

General knowledge of coding, care management and electronic medical record systems

Working knowledge of CMS developed clinical guidelines along with experience researching updates and changes to same.

Education:

Bachelor of Science in Nursing (BSN), required.

Master's degree, preferred.

Licensure/Certification:

Current and in good standing RN Licensure with South Carolina Board of Nursing.

American Heart Association Healthcare provider course with Basic Life Support (BLS) certification required to be initially completed with the TH Organizational Development Office within 30 calendar days of hire date (exceptions to obtain certification from a provider other than the TH Organizational Development Office are approved by TH Organizational Development on a case-by-case basis). BLS Recertification is required every two (2) years.

Skills:

Must be strongly proficient with PC's and Microsoft office software such as Word, Excel, PowerPoint, and Outlook.

Prior Electronic Medical Record experience, preferred.

Evidence of effective leadership including staff management, interpersonal skills, team building and consensus decision-making skills required.

Demonstrates strong written and verbal communication skills including delivering presentations to key stakeholders.

Data management and analysis that drives change and improvement, required.

Strong analytical and operational problem solving and critical thinking skills with the ability to be innovative and decisive when required.

Ability to be self-motivated to complete organizational projects and seek out the information necessary to achieve departmental goals.

Ability to manage multiple tasks and prioritize work to adhere to deadline and identified time frames. Valid and in good standing driver's license and personal transportation to be able to travel to multiple TH clinical sites, required.

Works with payers and internal stakeholders on clinical/operational strategies to improve care delivery.

Physical Requirements: Light Physical Agility Testing (PAT) Rating

While performing the duties of this job, the employee is frequently (activity or condition exists from 1/3 to 2/3 of the time) required to stand, sit, and walk; frequently to use hands, fingers; and frequently to talk or hear. The employee must exert up to 15 pounds of force occasionally (activity or condition exists up to 1/3 of the time), and/or up to 5 pounds of force frequently, and/or a negligible amount of force constantly to move objects.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job and will be measured by post offer Physical Agility testing with a required "Light" rating to verify ability to meet the requirement.