Director, Clinical Quality, Training, Oversight and Innovation

Inovalon

4d•$132,000 - $176,000•Onsite

About The Position

The Director, Clinical Quality, Training, Oversight and Innovation is engaged in defining and executing the overall clinical quality strategy and direction of the organization pertaining to data abstraction from medical records in any format for all Inovalon products. In addition, this position leads the design and execution of all clinical training and quality oversight for data abstraction for the organization and its vendors internationally. The position provides clinical direction to the Product, Operations, Client Services, and Innovation teams and drives clinical collaboration across these teams on a national level.

Requirements

Bachelor’s Degree in Arts/Sciences (B.A./B.S.) preferred
Active RN license required
Active RN license required with a minimum of 12+ years of relevant overall experience
6 years high level management experience, preferably in a Director level or higher role required
Minimum of 5 years’ experience in quality and/or compliance required
Minimum of 5 years’ experience in medical coding required
Minimum of 5 years’ experience with adult learning/training required
Outstanding attention to detail with the ability to set priorities and work on multiple tasks simultaneously
Strong computer skills required, specifically with Microsoft Office and data collections tools
Ability to manage and meet deadlines
Strong interpersonal skills
Professionally skilled in verbal and written communication
Applicants must be authorized to work in the United States as a condition of employment.

Responsibilities

Develop and maintain an expert level of knowledge regarding products, services, capabilities, infrastructure, and operations of Employer and its affiliates, the marketplace, competition, strategic positioning, threats and direction to achieve optimal insight and success with respect to Employer’s (and those of its affiliates) products, services, capabilities, support, functionality requirements, and financial performance.
Lead, drive, and ultimately be responsible for planning, implementation, execution, and successful achievement of the overall clinical quality strategy and direction of the organization pertaining to data abstraction from medical records, and the design and execution of all clinical training and quality oversight for data abstraction for the organization and its vendors internationally.
Serve as subject matter expert for risk-adjustment and HEDIS for the company, engaging frequently in client services functions as well as business development and marketing. Serve as an internal resource to drive and maintain Inovalon’s thought leadership in the RA and HEDIS industry. Participate in industry conferences as an expert presenter.
Responsible for training all internal staff, partners, and vendors internationally on accurate medical data abstraction (for all products, including RA and HEDIS) in compliance with all coding and regulatory requirements. This includes initial development and annual updates of all training materials annually or more frequently as appropriate.
Responsible (in collaboration with MRR Operations leadership) for quality oversight of all internal staff, partners, and vendors internationally in the performance of medical data abstraction (for all products, including RA and HEDIS), in compliance with all regulatory requirements. This includes identifying opportunity and driving execution of quality pullback processes and driving tool upgrades as warranted.
Responsible for execution of all Joint Quality Audit processes across RA and HEDIS clients, including promoting appropriate contractual language as permitted by Product leads. This requires significant client interaction with promotion of Inovalon’s best-in-class review process as well as representation of Inovalon’s position/performance in the context of third-party audits and other client-specific projects.
Serve as clinical expert in development/improvement of all tools/systems related to medical data abstraction.
Serve as clinical liaison to the Innovation team, collaborating to drive development and promotion of new market capabilities in the context of data abstraction (such as NLP). In addition, this position assists the Innovation team in performing its due diligence around onboarding new EMR partners to ensure CDE meets all clinical and regulatory requirements for use by Inovalon and its clients.
Responsible (in collaboration with relevant teams, such as Innovation) for design and execution of clinical quality oversight processes for ensuring clinical and regulatory validity of records received through EMR interoperability capabilities.
Maintain compliance with lnovalon's policies, procedures and mission statement.
Adhere to all confidentiality and HIPAA requirements as outlined within lnovalon's Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position.
Fulfill those responsibilities and/or duties that may be reasonably provided by lnovalon for the purpose of achieving operational and financial success of the Company.
Uphold responsibilities relative to the separation of duties for applicable processes and procedures within your job function.