Director of Performance Improvement

Catholic Health•East Farmingdale, NY

About The Position

The Director of Performance Improvement provides leadership and oversight for the Home Care Division's Performance Improvement Program, quality review activities, Infection Prevention and Control Program, Managed Care, regulatory compliance initiatives, medical review audits and appeals, and related risk management activities. The Director monitors clinical quality and organizational performance, including OASIS outcomes and Home Health Value-Based Purchasing (HHVBP), identifies trends and opportunities for improvement, and collaborates with clinical and operational leadership to develop, implement and monitor performance improvement initiatives. The Director oversees medical review activities and coordinates responses to Medicare and payer audits, including RAC, TPE, SMRC, MAC and commercial payer reviews, as well as the appeals process. The Director provides oversight of Managed Care activities, monitors federal and state regulatory requirements, supports regulatory readiness and survey activities, and oversees infection prevention and control activities. The Director participates in root cause analyses and corrective action initiatives and collaborates with Home Care and Catholic Health leadership and interdisciplinary teams to promote regulatory compliance, patient safety and quality outcomes. The Director leads Performance Improvement and other assigned meetings and committees and analyzes and presents clinical, operational, financial, regulatory and performance data, trends and recommendations to Home Care and Catholic Health leadership, committees and governing bodies.

Requirements

New York State Registered Nurse license
Master's degree in Nursing, Healthcare Administration, Business Administration, Public Health or a related healthcare field.
A minimum of five years of progressive management experience in a Medicare-certified home health agency
Strong knowledge of Medicare Conditions of Participation, OASIS, HHVBP, infection prevention and control, regulatory requirements, audits, appeals and home health reimbursement.
Strong leadership, analytical, communication, presentation and meeting facilitation skills
Proficient in Microsoft Office Suite, including Word, Excel, PowerPoint, Outlook and Teams

Responsibilities

Provides leadership and oversight for the Home Care Division's Performance Improvement Program, quality review activities, Infection Prevention and Control Program, Managed Care, regulatory compliance initiatives, medical review audits and appeals, and related risk management activities.
Monitors clinical quality and organizational performance, including OASIS outcomes and Home Health Value-Based Purchasing (HHVBP), identifies trends and opportunities for improvement, and collaborates with clinical and operational leadership to develop, implement and monitor performance improvement initiatives.
Oversees medical review activities and coordinates responses to Medicare and payer audits, including RAC, TPE, SMRC, MAC and commercial payer reviews, as well as the appeals process.
Provides oversight of Managed Care activities, monitors federal and state regulatory requirements, supports regulatory readiness and survey activities, and oversees infection prevention and control activities.
Participates in root cause analyses and corrective action initiatives and collaborates with Home Care and Catholic Health leadership and interdisciplinary teams to promote regulatory compliance, patient safety and quality outcomes.
Leads Performance Improvement and other assigned meetings and committees.
Analyzes and presents clinical, operational, financial, regulatory and performance data, trends and recommendations to Home Care and Catholic Health leadership, committees and governing bodies.