Physician Led Advanced Practice clinician driven geriatric care (care of older adults) team focused on the care of the frail, poly-chronic, elderly Medicare Advantage patients. This population is typically underserved and very challenged with access to care. To address these problems, we have elected to bring the care to the patient, instead of trying to bring the patient to the care. Care is provided throughout the entire continuum of care – from chronic care and urgent care in the home, to hospital, to skilled nursing facility, to assisted living, to palliative care, to end of life care.
The Medical Director of Quality is responsible for all quality management initiatives , including monitoring of Early Disease Detection (EDD), HEDIS and STAR measures. This candidate will provide leadership across markets, to ensure they are successfully implementing the Quality Management program, and continually monitoring for improvement and excellence in the quality of our patient care. The Quality Medical Director will help educate providers and staff, as well as community primary care physicians on Quality initiatives and EDD coding and documentation. This candidate will also ensure company remains compliant with all regulatory agencies. This person will be accountable to achieve continual improvement in quality metrics across the enterprise, enabling the company to fulfill their business and clinical vision and goals.
SKILLS & COMPETENCIES
• Fosters a culture of best demonstrated practices, customer and peer service-orientation, measurement, performance, accountability, and continuous improvement
• Develops and maintains collegial relationships with the Clinicians (both employed and network) in order to support the business efforts of the organization
• Educates Primary Care Physicians and front-line Clinicians on systems, structure, processes and outcomes that are necessary for assurance of regulatory compliance related to market activities
• Identifies best practices across markets, and helps implement new processes and efficiencies where needed
• Works with the clinical and operational team to ensure compliance with regulatory agencies such as NCQA, URAC, CMS, etc.
• Develops strategies for improving all aspects of market performance including Early Disease Detection (EDD), documentation, STAR, and HEDIS across all lines of business, including Medicare, Medicaid, Dual Eligible, and Exchange programs
• Oversees, reviews and audits health records for EDD and HEDIS/STARs
• Communicates with the network clinicians regarding coding audit results and areas for improvement
• Communicates with clinicians on HEDIS/STARs regarding care gap capture audit results and areas for improvement
• Collaborates with Market Medical Director and GMs to ensure markets set and meet EDD and quality metrics, and policies and procedures are in place
• Oversees all clinical processes and protocols for Coding department
• Mentors and monitors performance of direct reports to ensure they meet department and company objectives
• Conducts regular retrospective reviews for code capture accuracy, missed opportunities, consistency of documentation and education
• Defines, implements, and monitors strategies for improving clinical documentation resulting in quality of care and overall consistency of clinical documentation and coded data
• Provides direction and expertise to the training department on EDD (e.g. materials for appropriate clinical documentation and accurate diagnosis coding), HEDIS and Star measures and clinical/operational tools needed in the field
• Responsible for analyzing aggregate data/metrics and reporting to/reviewing with primary care physicians and company.
• Attends health plan and key health system Joint Operating Committee meetings when requested and ensure action items are followed up and resolved
• Attends and participates in operational or interdepartmental meetings as requested
• Other tasks needed to accomplish team’s objectives/goals
Educational/ Experience Requirements:
• Doctor of Medicine (MD) or Doctor of Osteopathy (DO)
• 5+ years’ experience with the geriatric population