Director of Quality and Clinical Excellence

Audit and Compliance

• Earn clinical documentation accurate and compliant with billing standards for Medicare, Medicaid, commercial insurers, and partner organizations, including RWJ and other health system partners.
• Review coding accuracy in relation to visit documentation, confirming that the billed level of service is supported by the clinical note.
• Own the chart-audit program across inpatient and outpatient settings, including new consults, follow-up visits, advance care planning documentation, and POLST documentation.
• Define audit methodology, including chart sample size per cycle, note types reviewed, review cadence, scoring approach, and escalation process.
• Career with external coding and compliance support, assemble representative note samples, and translate reviewer findings into team education, workflow improvements, and documentation standardization.
• Partner with Billing and Revenue Cycle Management on coding accuracy, time-based documentation, medical decision-making support, RVU worksheet accuracy, denial trends, and billing-risk trends.
• Lead documentation standardization through templates, macros, Epic, PointClickCare, Haiku workflows, and ambient AI documentation tools.
• Perform and oversee audits and inform the future hiring of audit and compliance staff with appropriate billing and compliance expertise.

Clinical Competence

• Ensure practitioners progress toward mastery of serious-illness communication, symptom management, interdisciplinary care, and high-quality palliative care practice.
• Define expected competencies at key milestones, such as 3, 6, and 12 months, and establish an ongoing competency review cadence after year one.
• Develop a clear scoring scale, such as not yet meeting competence, competent, and exceeding expectations.
• Design and oversee direct-observation “ride-along” visits, including determining who conducts them and how often they occur.
• Partner with Team Leads, quality team members, and senior clinical leadership to ensure competency reviews are consistent, constructive, and aligned with organizational standards.
• Develop scoring tools consistent with the competency framework and build the Team Lead spot-checking quality assurance function as part of the team’s 90-day plan.
• Connect competency results to education, coaching, remediation, and professional development in partnership with the Director of Professional Development and Clinical Practice.

Outcomes and Performance Measurement

• Evaluate performance against program KPIs, including readmission-risk reduction, fewer unnecessary emergency department visits, increased appropriate hospice utilization, clearly documented advance care planning, and improved patient and family communication and satisfaction.
• Evaluate hospital-facing team outcomes, including decreased hospital mortality where applicable and measurable.
• Assess the feasibility and value of provider-specific outcome measurement where current measures exist primarily at the hospital or program level.
• Develop and implement a patient and family satisfaction measure for the outpatient setting.
• Use quality and outcome data to identify trends, gaps, opportunities for improvement, and areas requiring focused education or intervention.

Certification and Audit Readiness

• Serve as the internal authority on what must be in place when external auditors, surveyors, payers, or certification bodies arrive.
• Operate a continuous quality loop: set standards, collect data, audit performance, identify gaps, build action plans, educate, re-audit, and report results.
• Lead the NJPCS Quality Committee and recurring quality reviews.
• Deliver monthly dashboards and quarterly reports to clinical and executive leadership.
• Develop and oversee performance-improvement projects, including project goals, interventions, timelines, responsible parties, and re-audit results.
• Track goal attainment and ensure findings lead to measurable improvement, education, remediation, and accountability.

Governance and Reporting

• Operate a continuous quality loop: set standards, collect data, audit performance, identify gaps, build action plans, educate, re-audit, and report results.
• Lead the NJPCS Quality Committee and recurring quality reviews.
• Deliver monthly dashboards and quarterly reports to clinical and executive leadership.
• Develop and oversee performance-improvement projects, including project goals, interventions, timelines, responsible parties, and re-audit results.
• Track goal attainment and ensure findings lead to measurable improvement, education, remediation, and accountability.