Clinical Quality Manager

Metro Vein Centers•Detroit, MI

4d•Remote

About The Position

Metro Vein Centers (MVC) is seeking a Clinical Quality Manager to spearhead the growth and optimization of our national clinical performance. Reporting to the Director of Clinical Documentation & Coding, this remote leader will serve as the technical expert for clinical quality, value-based care, and clinical documentation improvement initiatives. You will be responsible for bridging the gap between clinical data and operational excellence, ensuring MVC maximizes its quality scores and reimbursement potential through rigorous analysis and change management.

Requirements

In-depth knowledge and experience with Healthcare Effectiveness Data and Information Sets (HEDIS), CMS Quality Payment Programs (QPP), Advanced Alternative Payment Models (APM), Merit-based Payment Systems (MIPS), and payer specific Quality Initiative Value-Based Reimbursement programs.
Ability to navigate Electronic Medical Records (EMR), data reporting (Tableau), and Google Sheets/Microsoft Office systems efficiently.
5+ years of physician revenue cycle experience with a focus on clinical quality standards at a national level.
5+ years of experience leading clinical quality efforts and change management in a fast-growth environment.
Associate’s degree or higher in Business, Healthcare Administration/Management, HIM, Informatics, or associated track.

Nice To Haves

CPHQ or CHQM highly preferred. Open to other relatable certifications.
CPC, CPMA, CCS, RHIT, or CDIP certifications are a significant plus.
Previous experience with Athena Practice (GE Centricity) EMR.
Experience within vascular or vein-specific clinical environments.
Experience as an LPN, RN, NP/PA, or FMG/IMG.

Responsibilities

Conduct deep-dive reviews of current documentation and workflows within the electronic health record (EHR) to identify gaps in quality and compliance.
Assist with clinical documentation training and feedback sessions for providers to ensure evidence-based standards, documentation, and coding accuracy requirements are met.
Identify all qualifying opportunities, and Develop, Implement, and Monitor MVC’s pay for performance/value-based incentive programs to ensure alignment with specific payer contracts.
Develop and analyze new and existing data reports to communicate performance trends and "red flags" to leadership teams.
Identify opportunities for automation and software enhancements to streamline quality reporting and documentation auditing & coding workflows as the practice grows.
Establish a unified clinical roadmap that aligns national clinical guidance with regulatory & payer requirements and organizational strategy. Ensures clinical operations are within regulation and meet the highest level of quality.
Build partnerships across IT, Credentialing, and Clinical Operations to ensure clinical guidance meets both business and patient needs.