Director of Ambulatory Regulatory Compliance and Performance

HH MedStar Health Inc. • Columbia, MD

47d

About The Position

Medstar Ambulatory Services Inc is a non-profit organization operated for the purpose of supporting and encouraging quality healthcare and related services. Based in Columbia, Maryland, we are committed to making a positive impact in our community's health and wellbeing. As part of the broader MedStar Health network, which is the leading healthcare provider in Maryland, DC, and Virginia with over 500 specialty, urgent care, and primary care locations, we leverage our connections and expertise to maximize our charitable impact.

Requirements

• Master's degree in related field required or an equivalent combination of education and experience required and Bachelor's degree in clinical specialty. required
• 5-7 years Experience in healthcare leadership and/or consulting including medicare regulatory programs leading quality assessment and improvement programs familiarity with cerner millennium her and cerner healtheintent/healtheregistries. Experience with Medicaid and/or commercial pay-for-performance programs. required
• RN - Registered Nurse - State Licensure and/or Compact State Licensure Current RN license required or license appropriate to clinical discipline required
• Excellent problem-solving and organizational skills.
• Ability to exercise independent judgment.
• Business acumen and leadership skills.
• Strong verbal and written communication skills with ability to effectively interact with all levels of management internal departments and external agencies.
• Working knowledge of Microsoft Word PowerPoint and Excel.

Responsibilities

• Ambulatory quality measures - Serves as a subject matter expert for ambulatory quality measures regularly reviews/assesses healthcare regulatory policies to identify regulations and standards which impact the ambulatory environment. Reviews annual updates to ambulatory quality measures to determine if workflows EHR forms or components and/or measure mapping need to be updated.
• Medicare Quality Payment Program (Medicare QPP) - Serves as a subject matter expert for requirements and opportunities within the Medicare QPP and where necessary and appropriate develops and provides education about these policies regulations and standards to relevant MedStar Health teams. In conjunction with the AVP for Quality and Safety and other designated members of the Quality and Safety team annually determines and develops strategies for optimal scoring/ financial return for each component of MIPS for each of the MedStar TINs and/or subgroups participating in MIPS including opportunities for exceptions and/or extra credit points.
• Monitors progress on each component and revises strategies where necessary. Develops end-of-CY projections for performance and present these to the AVP for Quality and Safety and TIN clinical and operational leadership and when requested recommend end-of-CY remediation programs for optimal performance. Annually determines and develops strategies for optimal scoring/financial return for the quality component of Advanced APMs within the Medicare QPP ( should MedStar be participating in any).
• Reviews group/TIN/provider eligibility status (via the QPP portal) throughout the year. Runs and/or reviews reports from PUBs CMS and MedConnect quarterly and highlights changes for MedConnect Application team - Identifies the Provider/TIN association for submission. Communicates updates to MedConnect IS so that updates to Bedrock provider tables are completed.
• Reviews standards for reports - ensures all reports/supporting documents are completed before end of each CY. Management of annual attestations and reporting for all MedStar TINs reporting under MIPS excepting those MedStar TINs whose reporting is conducted by a 3rd party.
• Medicaid Value Based Program (MedStar Family Choice) - Annually review updates to Medicaid quality measure requirements and thresholds and collaborates with clinical and quality leads for MedStar Family Choice on performance monitoring. Collaborates with Advanced APM clinical and operational leadership to advise on options for qualifying participants in the Medicare QPP and facilitate APM reporting to CMS.
• Commercial value-based payment programs - Annually reviews updates to existing commercial quality measure requirements/thresholds and present this review to the AVP for Ambulatory Quality and Safety and the relevant leaders within Managed Care. Where asked collaborate with Quality and Safety Managed Care and MMG clinical and operational leadership in advising on and/or developing quality measure remediation programs
• Participates in multidisciplinary quality and service improvement teams and maintains effective working relationships with other departments.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Industry: Ambulatory Health Care Services
• Number of Employees: 5,001-10,000 employees