Corporate Director of Clinical Quality

About the role

The Director of Clinical Quality reports to the Vice President of Clinical Quality. The role involves direct involvement, chart reviews, IDG attendance and oversight of corrections needed. Evaluating needs in the individual branch and establishing a plan for implementing changes and improving documentation. Helping develop a process of accountability to ensure overall quality improvement.

Responsibilities

• Analyze office risk level and develop an action plan upon initiation of a CMS audit, including education, audit initiation, interdisciplinary group review, calls to assist virtually and/or possible on-site visits.
• On-going assessment of the branch will be provided on a regular basis and weekly reports to the VP of Clinical Quality will be provided to analyze outcomes and possible changes in plan.
• Aids with claim denials and in the resolution of claims.
• Collaboration with the Director of Clinical Operations and Vice President of Clinical Operations to ensure coordination and delineation of roles and responsibilities related to support and education actions.
• Ensures compliance with local, state and federal regulations and accreditation standards. Provides support, direction and feedback to staff during the clinical compliance process.
• May delegate responsibilities to ensure follow-up to resolution of each action item identified.
• Proactively assesses office performance and implements changes to prevent non-compliance. Communicates with up-line manager, Chief Clinical Officer, Chief Compliance Officer, legal department, Utilization Management and other corporate resources as appropriate to address/resolve issues.
• Might work as support or backup to a Director of Clinical Operations at times when increased survey response is needed. This role would be a resource to help manage and contribute when appropriate.
• Supports offices with quality measures in all areas which may include but not limited to claim denials, quality metrics, quality reviews and quality care.

Requirements

• Extensive knowledge in the areas of documentation, and the interpretation and application of regulations and performance improvement standards required.
• Knowledgeable in federal, state, and local regulations, as well as federal guidelines for hospice services.
• Knowledgeable in OSHA regulations.
• Experience building and leading high-performing teams; mentoring team members.
• Confident presenter and persuasive speaker.
• Ability to communicate effectively; excellent interpersonal skills.
• Ability to manage multiple projects and meet deadlines.
• Strong follow up skills.
• Exercises professional judgement and demonstrates excellent problem resolution skills.
• Experience with Lean Six Sigma (LSS) tools and methodologies preferred.
• Strong attention to details.

Qualifications

• Bachelor’s or advanced degree in Nursing.
• Minimum of 5-years experience in nursing, 3 in hospice and 2 of which have been in a management role for a certified agency preferred.
• Valid driver’s license and auto liability insurance coverage.
• Unencumbered and active RN license in state of residence required.

Skills

• Computer skills to include solid knowledge of Microsoft Office Suite including Excel.
• Experience using reporting tools and databases to review data in electronic systems.
• Experience working with Homecare-Homebase preferred.

Benefits

• Competitive Pay
• 401(k) with Company Match
• Career Advancement Opportunities
• National & Local Recognition Programs
• Teammate Assistance Fund
• Additional Full-Time Benefits
• Medical, Dental, Vision Insurance
• Generous Paid Time Off + 7 Paid Holidays
• Wellness Programs (Telemedicine, Diabetes Management, Joint & Spine Concierge Care)
• Education Support & Tuition Assistance
• Company-paid Life & Long-Term Disability Insurance
• Voluntary Benefits (Pet, Critical Illness, Accident, LTC)