Ambulatory Quality Reporting & Improvement Manager

Overview

The manager for the Quality Reporting and Improvement Specialist and Chronic Care Manager/Quality Improvement nurses has considerable experience with quality reporting, payor quality incentive programs, gap closures and quality improvement.

The Ambulatory Quality Reporting & Improvement Manager will maintain an understanding of all programs to be able to assist with training and support of team members. They will be the “expert” for quality incentive programs collaborating with the other team members, Director of Ambulatory Quality, data analysts, Epic & operational teams. Responsibilities include verification of initial attribution lists, track changes to attribution during the year, & communicate quarterly FH provider changes to the payers & processing of quality reports.

Works directly with the Ambulatory Quality director to lead the FHPG P4P program. The manager will assist with the coordination of meetings with payers related to quality, work with development of training related to staff workflows to meet quality measures and assist the Epic team with measure build, review, and updates.

• The manager works collaboratively with the CCM nurses, health care teams & patient’s family to ensure they have what they need to coordinate patients care while decreasing inappropriate emergency department visits and readmissions to the hospital. Assists the team with closing patient care gaps, updating health maintenance topics in Epic, assist with resolution of suspect conditions in value-based contracts, and ensuring medication adherence for payor quality incentive programs.

• Bachelor’s degree in business, Healthcare Administration preferred; experience may be accepted in lieu of education or formal training.
• Licensure / Certification Requirements
• Five years’ experience in physician group practice that utilizes EMR and billing systems to provide audits, analysis, reporting and training.
• Minimum of three years’ experience working with healthcare quality and value-based programs with current knowledge of programs such as MIPS, Hedis, PCMH and MSSP preferred.
• CPC & Lean certifications preferred, but not required.
• Intermediate knowledge and proficiency in computer systems especially Windows, Microsoft Office, and Power Point. Minimum of 2 years’ experience with Lean and/or Six Sigma preferred.
• Reliable transportation and valid driver’s license.
• Minimum of three (3) years’ experience in supervisory responsibilities.
• Must have Financial/analytical skills with tensive knowledge of insurance rules, including but not limited to reimbursement, third party payers, pre-certification, ICD-10, and CPT coding. Ability to lead others. Strong organization and people skills. Must be proficient in software applications.