Director of ClINICAL AUDITING  sERVICES

Since 1996, the healthcare research and technology professionals at Outcomes Health Information Solutions, LLC have been defining and refining the business of acquiring health information.  Our single mission is to promote the improvement of health outcomes by optimizing the acquisition and mobilization of patient data.  Today, Outcomes is the nation’s largest full-service firm dedicated exclusively to the acquisition, management and use of health information.  We provide Payment Integrity Auditing, Health Outcomes Improvement Services (including HEDIS® and other retrospective and prospective health outcomes studies), Health Advocacy Programs (chronic condition and disease management support), and a full suite of health information technology services (ODIS iTools™). 

POSITION SUMMARY

Responsible for managing local real-time operations for a staff of 100+, and for providing support to the Senior Vice President of Auditing Services.  Maximizes the resources (human and automated) to achieve customer satisfaction, productivity, meet project deadlines and economic goals. Works closely with the Senior Vice President to implement and coordinate both strategic and tactical plans to enhance operational and service performance.  Analyze and engineer new operational processes based on efficiency and effectiveness improvements.   

REQUIRED EDUCATION & EXPERIENCE

Bachelor’s Degree required, Masters Degree preferred;

Nursing Degree required, preferred Bachelor’s;

Three to five years of related experience in the field or a related area; and

Five years of management experience.

Preferred HEDIS® experience

Preferred Medicare Risk Adjustment experience

ADDITIONAL REQUIREMENTS

Strong problem-solving and analysis skills required;

Ability to balance and adjust resources as priorities change;

Ability to evaluate and plan effectiveness and adjust as necessary;

Ability to make administrative and procedural decisions and judgments;

Ability to foster a cooperative work environment;

Ability to problem solve; able to identify and analyze work-related issues in a systematic and timely manner;

Skilled in leadership techniques; serves as a model of ethics and integrity;

Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community;

Proven computer proficiency (Power Point, Word, Excel, Access);

Excellent data analysis skills (Excel, Access).

SUMMARY OF DUTIES & RESPONSIBILITIES

Directs daily activities of the Clinical staff, including Registered Nurses, Licensed Practical Nurses, Certified Coders and on-site support staff.

Fosters and maintains a collaborative relationship with internal and external business partners to maximize scheduling and real-time utilization of resources

Analyzes current and projected staffing needs. Identifies, recommends, and facilitates staffing increases or decreases to ensure smooth-coordination of scheduling and maximization of schedule adherence.

Continues monitoring of progress to achieve short term and long term goal benchmarks.  Proposes changes to departmental plans if deemed necessary from assessment with prior approval by SVP of Auditing.

Communicates and follows-up to ensure departmental staff is fully informed of all new information related to procedures, customer needs and company related issues, changes or actions.

Ensures Registered Nurses, Licensed Practical Nurses, Certified Coders  the and departmental Managers are performing at top efficiency by working with and leading teams to achieve increased productivity with high levels of quality and customer service.

Develops and enacts contingency plans as needed.

Proactively identifies potential problems, troubleshoots, and keeps senior management informed of results.  Participates and provides input in debriefing analysis of problems and future process improvements.

Strategize to meet immediate operational needs of respective departments.

Works in a collaborative manner with Management to ensure the attainment of common short and long term goals.

Develops strategic short term and long term plan including benchmarking, resource planning, initiatives and deliverables.  Collaborates with VP of Operations to finalize short term and long term plans.

Conducts and participates in daily, weekly, monthly and annual organizational and team planning meetings as appropriate.

Maintains a positive work environment that supports high performing teams and rewards people based on performance through effective communication.

Provides on-going coaching to assigned managers and supervisors on their team’s performance in relation to quality of service, reliability, availability and retention.

Performs other duties and responsibilities as required or requested.