Corporate Director of Clinical Quality

Overview The Director of Clinical Quality reports to the Vice President of Clinical Quality. The Director of Clinical Quality is responsible for direct involvement, chart reviews, IDG attendance and oversight of corrections needed. This role evaluates needs in the individual branch and establishes a plan to implement changes and overall improvement of documentation. This role helps develop a process of accountability to ensure improvement of overall quality. The Director of Clinical Quality will develop, when applicable, and direct the implementation of corrective action plans in branches as a result of unfavorable internal survey or external conditional survey outcomes. Essential Functions Upon initiation of a CMS audit which may include Targeted Probe and Educate, UPIC, SMRC and/or any other audit activity, the Director of Clinical Quality along with the VP of Clinical Quality will analyze the office risk level and develop an action plan. This will include but not limited to 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 would be maintained to ensure coordination is maintained and delineate 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 noncompliance. 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. May work as support or back up 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. Direct and monitor resolution of identified deficiencies in conditional surveys. Support offices with quality measures in all areas which may include but not limited to claim denials, quality metrics, quality reviews and quality care. About You Specialized Knowledge/Skills: Extensive knowledge in the areas of documentation, and the interpretation and application of regulations and performance improvement standards required. Must be knowledgeable of 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. Education/Experience: 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 License/Certification: Valid driver’s license and auto liability insurance coverage Unencumbered and active RN license in state of residence required if RN. Training/Equipment 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 We Offer Benefits for All Associates (Full-Time & Per Diem): 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) Legalese This is a safety-sensitive position Employee must meet minimum requirements to be eligible for benefits Where applicable, employee must meet state specific requirements We are proud to be an EEO employer We maintain a drug-free workplace #J-18808-Ljbffr Gentiva