Supervisor, Medical Quality - PDS Health

Now is the time to join PDS Health. You will have opportunities to learn new skills from our team of experienced professionals. If you're ready to take your career to the next level and gain valuable experience, apply today!

The Supervisor, Medical Quality is responsible for overseeing the Medical Quality Assurance team and ensuring the highest quality of care for patients. The Supervisor will interface with contracted Medicare Advantage plans to maximize the organization's financial return on meeting CMS requirements. The Supervisor will also develop, monitor, and present internal quality measures, initiatives, and opportunities, and assess, track, and report quality outcome incentive metrics, performances, and results. Additionally, the Supervisor will use data to drive decisions, plan and implement performance improvement strategies, and design/implement an overall department structure that maximizes technology use, staffing, and staff and operational performance standards.

Responsibilities

• Provide effective leadership, coaching, mentoring, training, and development of the Medical Quality Assurance team members.

• Oversee and manage assigned engagements and activities related to medical quality assurance.

• Coordinate, track, and report clinical outcomes and follow-up on corrective action plans.

• Directly interact with the payors, patients, and office staff in preparation for meeting HEDIS measures.

• Acts as a liaison between medical coders and providers for questions around services rendered and payor reimbursement.

• Collaborate with healthcare providers to identify best practices and benchmarking opportunities to improve quality of care and patient outcomes.

• Maximize the organization's financial return on meeting CMS requirements.

• Develop, monitor, and present internal quality measures, initiatives, and opportunities.

• Assess, track, and report quality outcome incentive metrics, performances, and results.

• Use data to drive decisions, plan and implement performance improvement strategies.

• Design and implement an overall department structure that maximizes technology use, staffing, and staff and operational performance standards.

• Collaborate with internal departments to design and implement policies and procedures related to medical quality assurance and performance improvement initiatives.

• Review and analyze medical records to identify areas of improvement for patient care, documentation, and coding accuracy.

• Ensure compliance with CMS and other regulatory guidelines related to medical quality and performance metrics.

• Develop and implement strategies to improve clinical outcomes and patient satisfaction while maximizing financial returns for the organization.

• Conduct audits of medical records to ensure accuracy and completeness of documentation and coding.

• Provide education and training to medical staff and coders on HEDIS measures, CMS requirements, and other quality initiatives.

  Participate in quality improvement committees and task forces to drive performance improvement initiatives.

Qualifications

• Bachelor's degree in healthcare management, business administration or a related field. In lieu of a degree, 4+ years of experience is required or one of the combinations of education and experience.

• Minimum of 2 years of experience in healthcare quality assurance or a related field, 0-2 years of leadership experience

Knowledge/Skills/Abilities

• Familiarity with Medicare Advantage plans and CMS requirements.

• Knowledge of HEDIS measures and performance improvement strategies.

• Requires strong Microsoft Office, EMR, and Practice Management software experience, Epic experience preferred but not required.

• Ability to analyze data and use it to make decisions.

• Excellent leadership and communication skills.

• Strong organizational and project management skills.

• Ability to work collaboratively with internal departments and external stakeholders.

Benefits

• Medical, dental, and vision insurance
• Paid time off
• Tuition Reimbursement
• 401K
• Paid time to volunteer in your local community

Pacific Dental Services is an Equal Opportunity Employer. We celebrate diversity and are united in our mission to create healthier and happier team members.