Director of Quality and Clinical Excellence

Job Description

Job Description

The Director of Quality and Clinical Excellence leads the NJPCS Quality Program, which includes two connected areas: Audit and Compliance and Clinical Competence . Audit and Compliance ensures clinical documentation is accurate, complete, and compliant with payer and partner billing standards. Clinical Competence ensures practitioners progress toward mastery in serious-illness communication, symptom management, and high-quality palliative care practice while advancing the organization’s outcome goals.

Reporting to the Chief Clinical Officer and partnering closely with the Director of Professional Development and Clinical Practice, this role builds the audit tools, scoring instruments, dashboards, review cadences, and quality infrastructure needed to hold the program accountable. The Director also leads certification readiness, external-audit readiness, and continuous quality improvement efforts across NJPCS.

Essential ResponsibilitiesAudit and Compliance

Ensure clinical documentation is 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.

Coordinate 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.

Operationalize Joint Commission, CHAP, payer, and other applicable certification or audit standards.

Maintain certification readiness as a continuous lens across documentation, competency, performance improvement, facility readiness, and clinical practice.

Maintain the evidence base needed to demonstrate a functioning quality program, including policies, audit results, performance-improvement records, dashboards, committee minutes, and reporting.

Lead preparation for external audits, payer reviews, partner reviews, and certification surveys.

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.

Required Qualifications

Active clinical New Jersey license, such as APN or PA, with palliative care, hospice, or serious-illness experience; or demonstrated experience as a quality or compliance leader with deep palliative care, hospice, or serious-illness domain expertise.

Demonstrated experience leading clinical quality, QAPI, compliance, or performance-improvement programs in a healthcare setting.

Working knowledge of documentation, coding, and billing standards across Medicare, Medicaid, and commercial payers.

Familiarity with Joint Commission and/or CHAP certification standards and external-survey readiness.

Experience designing audit tools, scoring instruments, dashboards, quality reports, and KPI reporting processes.

Ability to evaluate clinical documentation, identify risk, provide feedback, and support documentation improvement.

Strong communication, organization, project-management, facilitation, and relationship-building skills.

Active DEA, CDS, ACLS, and BLS.

Preferred Qualifications

Billing and compliance experience sufficient to perform and oversee coding and documentation audits.

Experience with Epic, PointClickCare, Haiku, and/or ambient AI documentation tools.

Experience building or scaling a quality program across multiple care settings.

Experience partnering with billing, revenue cycle, data teams, clinical leaders, and external partners.

Experience with palliative care quality metrics, serious-illness communication standards, advance care planning documentation, and hospice utilization outcomes.

Core Competencies

Clinical credibility and the ability to evaluate practitioner skill in communication, symptom management, documentation, and palliative care practice.

Compliance rigor, with precise, defensible, and consistent judgment related to documentation, coding, and audit findings.

Data fluency, with the ability to turn audit results, outcome data, and quality trends into clear dashboards, decisions, and action plans.

Collaboration across clinical, billing, revenue cycle, professional development, data, operations, and external-partner stakeholders.

Program-building skills, with the ability to design, implement, and scale a structured quality program in phases while maintaining a strong foundation.

Ability to provide constructive feedback, support remediation, and promote accountability while maintaining a culture of learning and improvement.

Commitment to clinical excellence, patient- and family-centered care, ethical practice, and continuous quality improvement.

Key Working Relationships

Chief Clinical Officer; Director of Professional Development and Clinical Practice; Director of Clinical Operations; Lead APPs; preceptors; advanced practice providers; other clinical team members; data team; human resources; billing and revenue cycle management; interdisciplinary team members; external partners; and certification, payer, or audit representatives.

Success Measures

Audit program is operating on a defined cadence, with measurable improvement in coding and documentation accuracy that holds up under external review.

NJPCS is survey-ready at all times for Joint Commission, CHAP, payer, partner, and other applicable audits.

Competency framework is in place, including milestone standards, scoring tools, ride-along processes, and clear documentation of practitioner progression.

Practitioners demonstrate visible progress toward mastery in serious-illness communication, symptom management, documentation, and palliative care practice.

Program KPIs show improvement, including readmissions, emergency department utilization, appropriate hospice utilization, advance care planning documentation, patient and family satisfaction, and hospital mortality where applicable.

Clinical and executive leadership have clear visibility through reliable monthly dashboards, quarterly reports, and actionable quality updates.

Quality findings drive measurable change through education, coaching, remediation, performance-improvement projects, and re-audit gains.

Strong cross-functional partnership exists with Professional Development, Billing and Revenue Cycle Management, data, Team Leads, clinical operations, and site partners.