Quality Assurance Manager

2 months ago

Miami, United States Community Medical Group Full time
Job DescriptionJob Description

Summary

The Quality Assurance Manager is responsible for implementing the company’s Continuous Quality Improvement Program at the corporate level including, but not limited to, planning, organizing, developing, coordinating, and directing quality assessments. They will ensure activities and programs in facilities are accordance with current applicable federal, state, and local standards, guidelines, and regulations. They will ensure the highest degree of quality resident care and services are delivered and maintained with patients. Also, the Quality Assurance Manager is responsible for the development and implementation of the Corporate Compliance Program. They are responsible for the integrity of the system and ensuring it meets regulatory requirements and includes review of high-risk areas.

Duties and Responsibilities

  1. Performs root cause analyses and recommends appropriate actions to improve clinical and non-clinical outcomes.
  2. Develops Quality Assurance (QA) chart review check list and conducts QA activities.
  3. Develops, plans, and organizes corporate Compliance Program to include internal audit process for identified high-risk areas related to operational, financial and reimbursement processes.
  4. Coordinates and oversees external regulatory audit requests.
  5. Assists with development and coordinates the corporate Continuous Quality Improvement/Quality Assurance and Performance Improvement program with Senior Management to enhance the quality of resident care, in accordance with current rules, regulations, and guidelines that govern long-term care facilities.
  6. Evaluates programs and makes recommendations as necessary to improve programs and ensures compliance with regulatory requirements.
  7. Maintain an open constructive relationship as a liaison with facility management and staff and corporate management.
  8. Assists in developing follow-up procedures for monitoring identified problem areas.
  9. Collect and compile statistical quality data analyze data to identify areas for improvement in the quality system.
  10. Evaluate audit findings and implement appropriate corrective actions.
  11. Identify training needs and organize training issues to meet quality standards.
  12. Makes written and oral reports/recommendations to the facility Administrator, Regional Administrator, and corporate management, as required, concerning overall facility operations.
  13. Serves as liaison among committees and/or departments to focus on Quality Assurance/Performance Improvement in the on-going operation of the corporation.
  14. Evaluates programs and makes recommendations as necessary to maintain and/or improve programs and assure compliance with regulatory requirements of safety and infection control procedures.
  15. Meets billing operational standards by contributing billing information to strategic plans and reviews; implementing production, productivity, quality, and customer-service standards; resolving problems; identifying billing system improvements.
  16. Guides employee actions by researching, developing, writing, and updating billing policies, procedures, methods, and guidelines.
  17. Updates job knowledge by participating in educational opportunities; reading professional publications.
  18. Implement education, and provide formal training to providers and staff as needed regarding coding compliance, documentation guidelines, HCC (Hierarchies Criteria Conditions) education and Medicare / Medicaid regulations.
  19. Risk adjustment data validation support.
  20. Provider coding education and interdepartmental coding education support
  21. Create Policy and Procedures to be used within the department to support Best Practices.

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