Manager, Home and Community Care Quality

1 - Under the supervision of the Vice President, Home Health Services on an annual basis develops, coordinates and implements the Agency’s Quality/Performance Improvement Program assuring its consistency with South Shore Health System/Home and Community Care mission, policies and procedures as evidenced by the program manual.
   a - Prepares annual Quality/Performance Improvement Plan and Flow Chart and submits them to the South Shore Health System 
   b - Performance Improvement Committee and Agency leaders as evidenced by meeting minutes.
   c - Schedules and coordinates subcommittee reports for quarterly Quality Improvement Committee as evidenced by meeting minutes.
   d - Supervises the continuous quality improvement activities of the Clinical Record and Practice subcommittees of the Quality Improvement program.
   e - Assures the Quality Improvement Program meets Joint Commission and other regulatory agency standards as evidenced by successful review.
   f - Evaluates the program to assess effectiveness
   g - Prepares and submits the annual Agency Evaluation of the Quality Improvement Program and Department.

2 - On an ongoing basis act as a Chairperson for various subcommittees as evidenced by preparation and maintenance of agenda, minutes, monthly and quarterly reports.
   a - Assesses utilization review results to establish trends in documentation errors which might be improved by clinical record form development and revision.
   b - Assures all forms approved for use in the clinical record comply with Joint Commission standards, Conditions of Participation, and Agency policies and procedures.
   c - Acts as liaison between Record Subcommittee and Forms Committee.
   d - Communicates Record Committee activities to Agency staff through managers at bi–monthly meetings or at team meeting as evidenced by minutes.
   e - Coordinates with qualified persons to design new forms.

3 - On an ongoing basis assists the Home Care Administration Team of the Division to prepare for Federal regulatory surveys annually and Joint Commission survey every three years as evidenced by successful compliance audits.
   a - Reviews Joint Commission, Federal and State publications to be aware of any changes in interpretation or trends.
   b - Communicates most current regulations to peers and staff as evidenced by meeting minutes.
   c - Collaborates with other clinical stakeholders to develop and revise policies and procedures and design and streamline forms incorporating necessary regulatory criteria.
   d - Acts as resource for all administrative and clinical personnel.

4 - Provides a comprehensive orientation program for all new members of the clinical staff as necessary and as evidenced by orientation schedules.
   a - Requisitions new equipment.
   b - Coordinates and schedules classes, and specialty observation visits.
   c - Meets with Managers as applicable prior to each orientation to discuss issues relevant to orientation.
   d - Collaborates with Managers to identify specific learning needs of individuals and assess effectiveness of program.
   e - Maintains and revises content as necessary to remain compliant with current Joint Commission standards and changes in documentation requirements as evidenced by revised curriculum.
   f - Initiates process to assess competency of new staff as evidenced by clinical skills checklist in program log.
   g - Meets with new staff to discuss post–orientation evaluation to assess and possibly integrate suggestions into future orientations.
   h - Teaches designated classes as evidenced by orientation checklist.

5 - Actively pursues new developments in related clinical practice, education, Joint Commission standards, Federal Conditions of Participation and other regulatory requirements and participates in activities which contribute to professional growth and development by attendance logs/CEU’s.
   a - Attends at least one program annually that will meet individual goals identified.
   b - Shares information with peers and staff in formal in-service programs or during team meetings.
   c - Supervises and participates in development/implementation of Critical Pathways/Patient Outcome Plans.
   d - Participates in state and regional Home Care Alliance meetings.
   e - Attends and participates in SSH committees and subcommittees as directed.
   f - Maintains current certification/licensure.
   g - Acts as a resource for managers and staff.

6 - On an ongoing basis supervises all reimbursement activities performed in the Quality Improvement Department.
   a - Reviews payer requests for additional information to evaluate for a specific focus and communicates areas of concern to other managers at weekly meetings as evidenced by minutes.
   b - Maintains current knowledge of Medicare and Medicaid Conditions of Participation and develops protocols and documentation criteria to assure compliance as evidenced by memos.

   c - Analyzes reimbursement trends and develops procedures for most efficient and cost-effective use of Agency resources.
   d - Acts as a resource for all stakeholders.

7 - Is responsible for department’s operational excellence; assures department delivers quality services in accordance with applicable policies, procedures and professional standards.

8 - Produce accurate and timely dashboards and analysis, meeting organizational and departmental and agency deadlines.

9 - Develops financial models for productivity and revenue management control.

10 - Drive productivity and efficiency through collaboration with operational leaders to develop and publish financial and operational dashboards.

11 - Partner with operational leaders to create annual operating budgets consistent with the agency’s goals and exercises critical thinking in identifying variances to plan and determining solutions to those variances.

12 - Responsible for the preparation of all operational analytics for the agency.

13 - Manages human resources to assure quality services and promote positive employee relations.

14 - Is responsible for the fiscal management of department; assures proper utilization of organization’s financial resources.

15 - Effectively communicates departmental, organization and industry information to staff.
 

JOB REQUIREMENTS

Minimum Education

Bachelor’s degree and/or Master’s degree in appropriate discipline preferred

Minimum Work Experience

Two to four (2-4) years’ experience in Quality Improvement/Reimbursement preferred. 
Two to four (2-4) years’ progressively responsible experience in health care preferred.
3-5 years of Healthcare/Financial experience in a management role with demonstrated experience in financial leadership, oversight and direction.
Additional Knowledge and Abilities

•    Astute working knowledge in operations and analytics in areas of performance improvement, coding & documentation, revenue cycle, data analytics and operational requirements across clinical disciplines. 
•    Record of accomplishment of achieving results in rapidly changing environments. 
•    Knowledge of medical information technology as well as business applications and software. 
•    Success with data driven initiatives within a complex setting. 
•    Strong analytical skills.
•    Ability to effectively work as part of a team and work within cross-functional teams. 
•    Ability to analyze the needs of the organization on a short and long-term basis. 
•    Knowledge of community health practice.
•    Strong Microsoft knowledge in Excel, Power Point and Word.