Director, Clinical Quality, Training, Oversight and Innovation
About the role
Inovalon is a company founded in 1998 dedicated to transforming the healthcare ecosystem through technology and data. As a leader in healthcare, Inovalon focuses on providing data-driven solutions to empower its customers and improve healthcare outcomes.
Responsibilities
Develop and maintain an expert level of knowledge regarding products, services, capabilities, infrastructure, and operations of Inovalon and its affiliates.
Lead, drive, and be responsible for planning, implementation, execution, and successful achievement of the overall clinical quality strategy and direction of the organization pertaining to data abstraction from medical records, and the design and execution of all clinical training and quality oversight for data abstraction for the organization and its vendors internationally.
Engage frequently in client services functions as well as business development and marketing, serving as a subject matter expert for risk-adjustment and HEDIS for the company.
Participate in industry conferences as an expert presenter, serving as an internal resource to drive and maintain Inovalon’s thought leadership in the RA and HEDIS industry.
Train all internal staff, partners, and vendors internationally on accurate medical data abstraction (for all products, including RA and HEDIS) in compliance with all coding and regulatory requirements.
Oversee the quality of medical data abstraction performed by internal staff, partners, and vendors internationally, in compliance with all regulatory requirements.
Execute all Joint Quality Audit processes across RA and HEDIS clients, including promoting appropriate contractual language as permitted by Product leads.
Develop and improve tools/systems related to medical data abstraction, and collaborate with the Innovation team to drive development and promotion of new market capabilities in the context of data abstraction.
Maintain compliance with Inovalon's policies, procedures, and mission statement, adhering to confidentiality and HIPAA requirements.
Manage and meet deadlines, prioritize tasks, and communicate effectively with various stakeholders.
Support the Innovation team in due diligence around onboarding new EMR partners to ensure CDE meets all clinical and regulatory requirements for use by Inovalon and its clients.
Design and execute clinical quality oversight processes to ensure clinical and regulatory validity of records received through EMR interoperability capabilities.
Requirements
Active RN license required with a minimum of 12+ years of relevant overall experience, and 6 years high level management experience, preferably in a Director level or higher role.
Minimum of 5 years’ experience in quality and/or compliance required.
Minimum of 5 years’ experience in medical coding required.
Minimum of 5 years’ experience with adult learning/training required.
Qualifications
Bachelor’s Degree in Arts/Sciences (B.A./B.S.) preferred.
Skills and Abilities
Outstanding attention to detail with the ability to set priorities and work on multiple tasks simultaneously.
Strong computer skills required, specifically with Microsoft Office and data collections tools.
Ability to manage and meet deadlines.
Strong interpersonal skills.
Professionally skilled in verbal and written communication.
Benefits
Inovalon offers a competitive salary and benefits package, including performance-based incentives, health insurance, life insurance, company-paid disability, 401k, 18+ days of paid time off, and more. Inovalon is committed to equal employment opportunity and fosters an inclusive work environment.