What are the responsibilities and job description for the Director of Compliance and Contracting position at ZÖe Center for Pediatrics & Adolescent Health, LLC?
This position will manage several key functions for both ZOe Pediatrics and ZOe ABA:
Responsibilities
- Manage the Credentialing and Contracting Department for all of ZOe Pediatrics lines of business.
- Manage Medical Records department and staff.
- Oversee the credentialing and re-credentialing process for healthcare providers.
- Educate clinical staff on quality improvement processes, best practices, and new initiatives.
- Manage all Quality Improvement contracts inclusive of, but not limited to NCQA recognition, HEDIS P-4-P,
- Monitor patient safety initiatives, including identifying and addressing adverse events, near misses, or safety concerns.
- Conduct in-house audits to ensure compliance with all relevant regulations and standards, including those set by Medicare, Medicaid, and other regulatory bodies.
- Investigation of all Quality Breeches.
Qualifications
- Nursing Degree (RN, BSN, or higher) with a valid nursing license.
- Experience in clinical nursing practice, with a focus on quality improvement, patient safety, or similar areas.
- Strong knowledge of quality improvement methodologies .
- Strong knowledge of contracting with commercial and Medicaid entities.
- Analytical skills and experience with data collection, analysis, and reporting.
- Familiarity with healthcare regulations, accreditation processes, and compliance standards (e.g., DCH, Department of Insurance, CMS, HEDIS and NCQA).
- Strong communication, leadership, and collaboration skills.
Salary : $80,000 - $90,000
