HCA, Hospital Corporation of America Senior Manager of Quality and HCC in Foster City, California
JOB TITLE: Senior Manager, Quality Improvement and Risk Management
The HCA Physician Services Group (PSG) is the physician and practice management solution for the Hospital Corporation of America (HCA). PSG operates more than 750 practices and partners with HCA’s 165 hospitals to structure employed provider programs, professional service agreements, and joint ventures that offer the communities we serve high quality, cost effective care. We manage a collection of highly motivated and innovative leaders who are committed to excellence in every aspect of their career.
Reporting to the CFO, the Senior Manager’s primary function is to develop and implement all quality and risk management programs required by health plan contracts and essential to the revenue of our IPA clients. Programs include IHA Pay for Performance, CMS 5 Star, and HCC coding for CMS.
DUTIES AND ESSENTIAL JOB FUNCTIONS
Provide strong leadership and visionary direction on behalf of the QI Team across all departments to drive departmental and organizational goals.
Work with health plan partners, physician community, and internal clients to develop and implement quality improvement and risk management programs in accordance with health plan and regulatory requirements.
Drive cross-functional collaboration to ensure the highest ratings for utilization, P4P, HCC coding to ensure quality, value based patient care.
Manage reporting results to the physician community that communicate clearly their performance results and gaps in care of the patient population. Influence physicians to take action to fully assess health status of their members and document findings
Develop and implement programs to educate physician community and office staff on drivers of performance and HCC coding including documentation and submission to the MSO for regulatory adherence.
Identify and implement programs targeting health promotion of IPA membership that also drive success of quality and risk management.
Manage the accuracy and productivity of the QI staff ensuring compliance with all regulatory and health plan contract requirements. Develop staff goals and training plans to maintain working knowledge of regulatory requirements as well as enhance overall contribution to the organization.
Ensure timely compliance with all state, federal, and health plan regulatory reporting requirements.
Work with the PPMSI medical management team to develop tools and methods of identifying and managing high risk patients.
Facilitate processes for tracking and improving quality gate targets for identified patients, as required by the accountable care and medical management programs.
Ensure regulatory changes are incorporated into al software and reporting systems.
Create and provide metrics to track success of programs including cost/benefit analysis, RAF revenue lift, and cost savings results.
Maintain a comprehensive working knowledge of community resources, payor requirements, and network services available to the target population.
Education and Experience:
Bachelor Degree from a four-year college or university.
Experience in Project Management including work plan creation, budget and resourcing.
Minimum of 3 years of previous experience in a managed care organization or other comparable experience for Quality Improvement P4P, CMS 5 Star, and CMS HCC.
Possess excellent written, verbal and interpersonal communication skills utilizing utmost discretion with sensitive and confidential information. Effective and persuasive presentation skills on controversial or complex topics to Leadership Team and external clients.
Working knowledge of coding for HCC.
Ability to research Pay for Performance and HCC issues, read, analyze, and interpret professional journals, technical procedures, or regulatory requirements relevant to accurate financial reporting
Experience using a variety of software, spreadsheets and word-processing, used in an integrated computer environment. Ability to expertly use MS Office Suite of applications
Ability to work independently, organize time and set priorities to meet established deadlines and to shift priorities and workload to frequently accommodate new and more urgent tasks.
Demonstrated ability to maintain a professional demeanor during interaction with a wide variety or personalities in demanding situations.
Ability to maintain cooperative working relationships with the staff, physicians, and administration working effectively as part of a team.
Must have the ability to define problems, collect data, establish facts and draw valid conclusions.
Title: Senior Manager of Quality and HCC
Location: California-Foster City-PPMSI
Requisition ID: 24614-46250