Director of Quality Management and Specialty Services
Posted on Jan 14, 2019 by Masonicare Home Health & Hospice
will be based
in Wallingford, CT. Apply online or email your resume to This role will oversee Oasis Review, Performance Improvement, and the Wound Care and Telehealth programs for the agency.
Previous homecare quality experience is a must.
Previous leadership experience is strongly preferred. We will consider RN, PT, and OT for this role. The
DIRECTOR OF QUALITY MANAGEMENT & SPECIALTY SERVICES
is responsible for the coordination and implementation of the Agency Quality Assurance/Performance Improvement Program - The Director of Quality Management and Specialty Services is responsible for oversight and direction of all performance improvement activities for Masonicare Home Health & Hospice including quality assurance, regulatory compliance and continuous survey readiness, programs consistent with established best practice and staff development initiatives for the agency. The Director also oversees the OASIS Review function, the wound program and the telemonitoring program incorporating all of these functions into an overall performance improvement plan. Essential Duties and Responsibilities: Establishes Agency standards of quality and outcomes of improvement: Works with Executive Director to ensure workflow processes are developed, implemented and continuously improved to achieve organizational goals. Works with and directs the Performance Improvement Committee and Professional Advisory Committee to ensure effective outcomes management. Coordinates Performance Improvement focus group activity. Coordinates and presents Performance Improvement program at Professional Advisory Committee and Performance Improvement Committee. Compile and present annual quality assurance reports to management, staff, governing bodies, and advisory committees as required on an agency wide basis. Analyze outcome and process measures through data collection, analysis, trending and monitoring.
Oversee the development of improvement plans to optimize patient outcomes. Analyze HHCAHPS measures, trending, monitoring and the development of improvement plans. Develop, implement, and evaluate systems for collecting data, evaluating care outcomes and evaluating goals for service delivery and care outcomes. Ensures compliance with all local, state and federal regulations including mandatory reporting: Oversee the development and annual review of policies and procedures necessary to align with best practice and state and federal requirements. Direct activities related to state and federal licensure and certification processes. Coordinates with Executive Director to manage efforts of the Clinical Managers to ensure that clinical data is accurate and that documentation is within state and federal regulation. Identifies areas of compliance or financial risk and works with Executive Director to minimize patient and agencies at risk situations. Chairs Policy Committee. Establish and oversee record review assuring compliance with state and federal guidelines and regulations. Ensures the integrity of medical records: Works with Health Information Manager to manage and maintain accurate, reliable data that complies with regulatory and Agency standards. Assures that all requests for documentation from state and federal entities is complete and sent timely. Implements education program based on identifies trends and anticipated clinical skills sets and regulatory requirements: Educates employees, communities and Board members on quality and outcome improvement efforts and demonstrates relevance to organizational objectives. Directs/supervises/participates in the efforts of the Education Specialist toward successful staff transition to home care/hospice, clinical competence and in Best Practice approaches for optimal clinical and financial outcomes. Coordinates educational efforts of the Education Specialist to address areas of high volume, high risk and importance to strategic and other initiatives. Medicare Claims Appeals, including Third Party Liability claims and ADRs: Oversees the activities of the Quality Manager to assure all ADRs are submitted timely to Medicare. As needed meets with staff to obtain additional clarification to documentation before submitting and provides education to staff about documentation. Is responsible for every level of appeals process for ADRs from redetermination to ALJ. Facilitates the receipt of additional evidence to support each appeal from staff and referral sources. Oversight of the Third Party Liability project for agency. Assures that all appropriate deadlines are met for each level of the project and coordinates the efforts of the various departments (HIM, PI and billing) to prevent recoupment of Medicaid dollars due to failure to comply. Oversees the process of Department of Social Services Audits and with other senior team members investigate findings to provide additional evidence to support claims. Directs/Supervises OASIS Specialists Responsible to ensure that OASIS is completed accurately and reliable Responsible to ensure that coding is compliant with ICD10 standard and according to coding convention for home care providers. Coordinates efforts with Executive Director and Education specialist to address areas where clinical education is necessary for staff to improve outcomes and accuracy of OASIS. Insures staff meets productivity and timelines standards for all duties. All other duties as assigned. Category: Quality Control , Keywords: Director of Quality Management