Primary Responsibilities and Specific Duties:
Aligns Providers to improve the cost and quality of care
Advises the Executive Leadership team on emerging trends, methodologies or issues in billing, coding, compliance or documentation issues
Works to improve market position, expand continuum of care, improve organizational performance and a better patient experience
Works effectively on projects with outside stakeholders, grant agencies, managed care and other groups as assigned.
Serves as the organizations designated Medicare Compliance Officer to ensure compliance with all existing and emerging requirements related to CMS
Serves on Organizational Committees such as QIC, Credentialing Committee
Quality of care:
Enhances collaboration and demonstrates compliance with recognized clinical best practices and improved outcomes.
Motivates and works one-on-one, in groups, at Provider Monthly Site Meetings, Provider Quarterly Meetings, or other training settings to assist Providers and/or other staff to work in a more united way to ensure the delivery of optimal, efficient care, and clinical integration.
The Chief of Quality tracks quality and outcome measures, an important facet of improving quality of care and increasing Pay-for-Performance (P4P) revenue along with meeting HRSA standards and goals
Provides analysis of data that is understandable to different audiences, such as providers and staff, leaders, executive leadership, QIC and Board of Directors
Monitors industry trends and takes required action on reports including Uniform Data Sets (UDS), Health Effectiveness Data Information Sets (HEDIS), Quality Dashboard, Meaningful Use, grant reports, Patient Centered Medical Home requirements and others as assigned.
Benchmarks performance against clinical industry standards
Acts also as an internal consultant and makes improvement recommendations as necessary
Facilitates rapid and seamless information sharing, thereby improving care continuity, eliminating duplicative diagnostic testing, and reducing the risk of medical errors
Promotes CHC and community-level disease management with attention to population health, thus improving overall health
Participates on the Quality Improvement Committee (QIC).
In partnership with the QIC Committee, other departments and leaders, develops, evaluates and implements process and/or policies and procedures for performance improvement.
Under the direction of the Chief Medical Officer (CMO) monitors the Quality Improvement plan, updates the QI procedure as necessary, leads the QIC when designated by the CMO
Implements and facilitates cross-functional teams to complete projects or assignments.
Able to work effectively on project with outside stakeholders, grant agencies.
Participates in periodic mock surveys to assess accreditation preparedness.
In addition to improving the quality of care, the Chief of Quality assists to reduce overall expenditures by managing costs at the patient level
Participates and acts as a liaison with all managed care organizations and other Payers as contracted with CHC and coordinates data for action
Ensures compliance with all applicable regulatory agencies and internal policies.
Other duties as assigned
MD or DO
3 years' experience preferred working in the areas of Quality, Data Outcomes, Process Improvement Projects, QI or QA activities within a healthcare entity
Knowledge of CMS regulations pertaining to Medicare and Medicaid preferred
Working knowledge of Microsoft Office, Excel Spreadsheets, portals and extensive knowledge of the components of medical records is required.
MD or DO, Board Certification preferred
Active Florida Medical License required or has applied for a Florida license
Excellent reading comprehension and writing skills including spelling and grammar.
Statistical analysis skills for trending analysis and report.
Ability to communicate effectively with clinical as well as non-clinical staff and express the QI mission with all its operational details.
Communicate with a high degree of professionalism in both writing and speech; maintain professional demeanor and dress.
Maintain confidentiality of all clinical and corporate data.
Proficient in electronic health record system.
Able to work flexible hours as needed.
Reliable transportation and current Florida Driver's license is required.
Travels to all CHC locations.