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Quality Improvement Manager

Company: MercyOne Des Moines Medical Center
Location: Clive
Posted on: January 25, 2023

Job Description:

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 record.
  • 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 improvement.
  • 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 standards.
  • Develop and support strategic efforts and improvement activities, including transparent measurement and performance reporting activities.
  • 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 indicators.
  • Participates in national professional and related organizations to ensure current knowledge of documentation and coding requirements.
  • Maintains positive, open communication with Chapter Directors, physicians and practitioners, and Medical Group leadership and staff.
  • Leads and sets agendas for frequent meetings with markets Medical Group leadership and co-chairs a statewide quality committee.
  • Counsels and continually monitors performance of Practice Coaches.
  • 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) preferred.
    • CCDS-O certification required within two years of hire.
    • Inpatient or outpatient Practice Coach experience strongly preferred.
    • Knowledge of risk adjustment payment methodologies strongly preferred.
    • 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 preferred.
    • Previous project management and process mapping experience strongly preferred.
    • Two years management experience strongly preferred.
    • Strong communication, written, interpersonal, and presentation skills.
    • 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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