Quality Program Manager

Company: CareMax

Industry: Private

Employment Type:  Full-time

Working Hours: 8 Hours

Job Location: USA

Full Job Description:

About us:

HEART. It is the driving force of our commitment to serving others with empathy, respect, and dignity. CareMax, is committed to providing the best that medicine has to offer with quality healthcare for those who need it most, our seniors. Join our team and experience it for yourself. We are Health with Heart.

We are looking for people with a heart for service and a desire for growth. As a Healthcare Sales Professional, you will contribute to our mission by serving as the liaison between CareMax and the community. You will utilize your skills to build strategic partnerships with health agents, health brokers, and potential members. Your efforts will focus on member attraction, enrollment, and retention.

You can count on us to provide you with resources and opportunities to grow and be your best, while contributing to our mission to improve lives through kindness, compassion, and better health. This is what we offer:

  • Access to continual education through CareMax University
  • Starting with 18 days of Paid Time Off
  • 8 company paid holidays
  • 401(k) plan with company match
  • Monthly car allowance
  • Competitive base salary
  • Bonuses
  • Comprehensive medical package

SUMMARY:

The Quality Manager directly contributes to reach the organization’s quality goals working with all patients from all health plans and LOBs. The Manager is responsible for coordinating and implementing the HEDIS and STAR’s data collection, supporting the Medicare Shared Savings Program (MSSP), and works under the leadership of the Quality Improvement Director to develop strategies for achieving performance goals for both programs. This role assists with quality data tracking and reports preparation to efficiently and effectively achieve CareMax performance goals. The Quality Manager may supervise a team of nonclinical staff who promotes and facilitates that the CareMax patients complete needed preventive as well as management tests and procedures, perform medical record review and process electronic data entry submissions. Provides direction and support to the Supplemental Data Entry team using routine communication to promote standard work processes. Acts as knowledge expert for continuous quality improvement activities, educating CareMax as well as practices staff. Assist with oversight and implementation of CareMax workflow processes and internal controls.

DUTIES AND RESPONSIBILITIES:

  • Provides quality analytic support to cross functional departments through creation and development of program, practice and provider level reports
  • Collaborates with provider clinic staff to execute the proper submission of medical records and data based on current HEDIS technical specifications.
  • Collaborates with the Quality Director in the development of training resources on STAR/HEDIS/MSSP Quality measures, to support proper collection of STAR/HEDIS/MSSP data.
  • Performs various quality department functions and processes, such as quality of care complaint/adverse event review, and assessment of medical record review results and recommend actions to address any identified improvement opportunities.
  • Participates in new hiring actions and on-boarding requirements for staff
  • Gathers and processes information needed to complete insurance claims and reimbursements; submits accurate electronic and/or hard copy claims to various payers
  • Assists in the coordination of flow of information between coding and other departments including Medical Records, Administration, Physicians and Medical Audits
  • Support the patient experience improvement interventions to make sure CareMax performs at 4 to 5 stars for all health plans
  • Provides leadership, support and training updates for staff that perform medical record review and data entry. Processes submitted data and information by providers for the capture of quality measure performance.
  • Assists with program strategy and planning.
  • Direct supervision of employees that may include disciplinary authority
  • Perform other related duties as required or requested.

QUALIFICATIONS:

  • Minimum 3 years of HEDIS/Quality experience with acquired progressive responsibility. Strong leadership and organization skills with the ability to achieve priorities, measurements, and strategic goals with limited/minimal supervision. Basic understanding of quality improvement standards such as NCQA, HEDIS, CAHPS, HOS and CMS
  • At least 2 years’ experience in managing and monitoring continuous improvement activities and/or projects, including and not limited to tracking key performance indicators.
  • Proficient knowledge of computers and typical production software (e.g., MS Office, Outlook, Word, Excel, PowerPoint, etc.).
  • Experience with SQL a plus
  • Experience and proficiency with different Electronic Medical Records
  • Position may require traveling, including and not limited to driving between site locations throughout assigned states and locations.
  • Ability to supervise staff working at multiple sites throughout the organization.
  • Ability to be a strong leader, build relationships with staff and physicians
  • An energetic, ambitious and dynamic personality.

EDUCATION:

  • Undergraduate degree required
  • In lieu of the above minimum requirements 3+ years medical business management experience in a physician group practice.
  • Advanced knowledge of MSSP, HEDIS and NCQA.
  • Experience with SalesForce
  • Knowledge and working experience with ICD10CM, CPT-4 and HCPCS official coding guidelines

Quality Program Manager

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