What are the responsibilities and job description for the Director of Quality Management position at EveryAge?
Job Title: Director of Quality Management
Reports to: Chief Quality and Compliance Officer
Key Responsibilities
- Ensure compliance by examining records, reports, and documentation; recommend improvements to internal controls.
- Monitor benchmarks and indicators (e.g., PEPPER reports) to identify billing risks and recommend improvements.
- Audit clinical and claims submissions to ensure accurate billing for acuity-based payment services.
- Monitor Value Based Purchasing reports and assist locations in developing improvement strategies; prepare quarterly summaries.
- Maintain policies and procedures in line with regulatory changes, as directed by the Chief Quality and Compliance Officer.
- Address compliance, policy, and regulatory questions; assist with problem-solving.
- Identify, investigate, and report compliance issues and violations.
- Support facilities during surveys and audits by accreditation organizations, Medicare, Medicaid, and third-party payors.
- Stay informed of regulatory changes affecting service delivery and reimbursement; maintain knowledge of relevant rules and regulations.
- Communicate with government agencies on behalf of the organization.
Qualifications
- Current Registered Nurse License in good standing with the State Board of Nursing.
- Graduation from an accredited School of Nursing with a Bachelor's Degree preferred.
- Ten years of progressive nursing experience, including at least five years of nurse management experience in a long term care facility, home health, and/or hospice.
- Strong understanding of federal and state long-term care regulations and survey process as well as the ADR process, reimbursement systems and processes is required.
- Strong analytical thinking skills and ability to maintain meticulous records of complaints and compliance activities.
- Good organization, communication and human relation skills required.
- Good computer skills required. Experience working with an electronic health record strongly preferred.
- Self-motivation, assertiveness and independent decision-making skills required.
- Attention to detail.
- Ability to handle multiple priority projects.
