Quality Improvement Manager
Company: MercyOne Des Moines Medical Center
Posted on: January 25, 2023
OverviewMercyOne Central Iowa operates four not-for-profit
Catholic medical centers in Des Moines West Des Moines Newton and
Centerville and two specialty hospitals MercyOne Childrens Hospital
in Des Moines and MercyOne Rehabilitation Hospital in Clive (965
beds total) along with more than 20 additional facilities that
house more than 50 primary care pediatric internal medicine and
specialty clinics. Founded by the Sisters of Mercy in 1893 MercyOne
Central Iowa has the longest continually operating hospital in Des
Moines and is also one of the largest employers in the state with
more than 7000 employees and a medical staff of more than 1000
physicians and allied health associates. MercyOne Central Iowa is a
member of MercyOne which was founded in 1998 through a
collaboration between CommonSpirit Health and Trinity Health two of
the countrys foremost not-for-profit Catholic health organizations.
MercyOne has more than 20000 colleagues in Iowa and surrounding
states.ResponsibilitiesGENERAL SUMMARY: -The Quality Manager
provides leadership, accountability and strategic direction for the
scope of the Practice Coach program to drive quality improvement in
clinical quality and medical record documentation across MercyOnes
value-based programs. Develops, oversees and continually refines an
education program aimed at improving clinical documentation,
population health segmentation; and increasing performance related
to completion of preventative care gap closures, Annual Wellness
Visits, and Advance Care Planning. Leads efforts to risk-segment
populations served, and develop standardized best-practices for
Medical Group adoption in line with evidence-based medicine,
documentation and coding requirements, and clinical measure
specifications. -ESSENTIAL FUNCTIONS:
- In conjunction with Data Analysts and Practice Coaches, leads
efforts to develop population health segmentation models for
patient risk categorization.
- In conjunction with the Data Analysts and Practice Coaches,
leads analysis efforts to identify unexpected variance, positive
and negative, of patient risk categorization.
- Develops improvement strategies to ensure that the level of
services and acuity of care are accurately reflected in the medical
- Leads Practice Coach efforts to review medical records for
patients in outpatient settings, primarily physician offices and
hospital-owned clinics; and working with providers through verbal
discussion, audits, and education to remedy issues.
- Leads Practice Coach efforts to collaborate with physicians,
practitioners, and Medical Group members to clarify clinical
documentation and quality measure requirements, and facilitate
- Apply clinical knowledge to evaluate how medical record
documentation translates into coded data, including chronic disease
and preventative processes, medications and their indications,
diagnostic information, and treatment plans.
- Leads and develops a robust education program that targets
providers for optimal documentation and disease processes to ensure
proper reflection of severity of illness, complexity, and acuity,
and facilitate accurate coding and billing.
- Develop and maintain expertise in various risk adjustment
payment methodologies (e.g. CMS HCC).
- Develop and maintain expertise in quality program measures
(e.g. Medicare Advantage STARS, Medicare Shared Savings Program,
Quality Payment Program).
- Develop and maintain expertise in relevant NCQA Accreditation
- Develop and support strategic efforts and improvement
activities, including transparent measurement and performance
- Works in conjunction with compliance to address discovered
instances of inappropriate coding and documentation.
- Develops and maintains staffing plans, detailing appropriate
employee classifications and qualifications consistent with the
demands of the Practice Coach program, and other relevant
- Participates in national professional and related organizations
to ensure current knowledge of documentation and coding
- Maintains positive, open communication with Chapter Directors,
physicians and practitioners, and Medical Group leadership and
- Leads and sets agendas for frequent meetings with markets
Medical Group leadership and co-chairs a statewide quality
- Counsels and continually monitors performance of Practice
- Conducts interviews with prospective employees; works with
Human Resources in hiring new personnel.QualificationsMINIMUM
KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:
- Possession of a current or compact state license as a
registered nurse issued/defined by the State of Iowa.
- BSN or other Healthcare related Bachelor degree required with
strong clinical background. Masters degree strongly preferred.
- Coding certification (RHIA, RHIT, CCS, CPC, CRC, COC)
- CCDS-O certification required within two years of hire.
- Inpatient or outpatient Practice Coach experience strongly
- Knowledge of risk adjustment payment methodologies strongly
- Knowledge of Medicare Advantage STARS, Medicare Shared Savings
Program and Quality Payment Program strongly preferred.
- Previous experience with multiple electronic medical records
(EMRs) strongly preferred.
- Previous experience performing qualitative and quantitative
analysis to develop evidence-based guidelines strongly
- Previous project management and process mapping experience
- Two years management experience strongly preferred.
- Strong communication, written, interpersonal, and presentation
- Extensive knowledge of ICD-10, DRG pay, or documentation
requirements and common documentation issues.
- Excellent computer skills and experience: word processing,
spreadsheet and database.
- Travel required to MercyOne Chapters and Medical Groups,
estimated +/- 60%
Keywords: MercyOne Des Moines Medical Center, Des Moines , Quality Improvement Manager, Executive , Clive, Iowa
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