Director, Payer Quality Performance

4 weeks ago

Linthicum Heights Maryland, United States University of Maryland Medical System Full time
Job Description

General Summary

This role will be responsible for the direction, program management and evaluation of quality performance measures. They will guide a team that identifies trends and make recommendations for clinical and operational quality improvement initiatives. Responsible for the management of quality reporting and compliance for multiple payer programs across the enterprise organization. This position supports the design, implementation, and maintenance of a comprehensive provider network/population health quality performance strategies that includes aligning multiple physicians and UMMS systems. This includes organizing and managing teams, developing project plans and schedules, managing issues, risks, costs, managing to schedule and scope and communicating at all levels of the organization. Manage staff during all aspects of the quality measure life cycle. This role should function as a recognized mentor, quality and regulatory role model. Provides clinical outcomes expertise through analysis of population health data (clinical quality measures) extracted from practice EHR, payer data and patient experience data. Serves as a lead in identifying health care trends in health outcomes, utilization, population and disease management, and patient experience. Partners with end users to identify their reporting needs and solutions.

Principal Responsibilities and Tasks

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. These are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

1. Serves as a leader between population health/payer quality programs; prioritizes problems for effective and timely resolution, and develops/communicates resolution plan/approach and recommendations.

2. Provides operational leadership to payer quality and population health programs and staff, while able to seamlessly manage projects as indicated leadership.

3. Responsible for managing assigned teams (internal staff as well as team members in other departments) to ensure project plan objectives remain on target and are achieved in accordance with the action plan deadlines

4. Oversees implementation plan development and coordination of resources to execute the plan In conjunction with clinical and administrative leaders, develops key priorities for advancement of clinical integration relative to program development and clinical quality improvement

5. Supports system-wide governance and committee infrastructure for payer quality programs

6. Works closely and in collaboration with leadership throughout organization, including practice transformation, clinical integration, finance, payer relations, performance improvement, care management, patient experience, marketing and communications, internal and external partners to set the strategic direction for program development, performance improvement and resource deployment

7. Understands UMMS population health vision, goals and strategies and communicates to others. Able to set clear goals and directions.

8. In conjunction with local hospital and practice quality leaders and clinical integration, supports the development of population-based registries, clinical practice guidelines, and evidence-based quality measures aimed at establishing, measuring and monitoring a high standard of clinical excellence for our patients.

9. Regularly communicates progress and impact to key stakeholders and senior leaders through KPIs and other scorecard tools.

10. Determines staffing requirements and directs the work of all direct reports to ensure effective and efficient departmental functions. Serve as resource, primary advisor, and mentor for all direct reports and cascading teams.

A. Hires, orients, trains, conducts performance evaluations, handles disciplinary issues, and provides an open and goal oriented work environment with establish clear and concise work procedures and productivity standards. Conducts performance reviews, and holds employees accountable for optimal performance of their responsibilities.

B. Develops personnel by providing opportunities and training programs to enhance individual employee’s career development.

C. Ensures full staff competency of technologies, regulations, policies and practices across the division.

D. Manages activities of contractors.

11. Implements and enforces departmental policies and procedures.

A. In coordination with departmental management, ensures compliance with regulatory and audit agency requirements.

B. Develops performance improvement initiatives aimed at improving customer service, operating costs, departmental functions/departmental productivity.

C. Develops and executes effective control process and compliance monitoring procedures to ensure risks are measured, monitored, controlled, and mitigated.

D. Represents the department at various meetings, task force groups, quality councils and with other members of the UMMS/QCN.

12. For complex projects or programs, direct the initiative using best-practice program management approaches to deliver against approved estimates for quality on-time and on-budget programs and projects.

13. For programs consisting of multiple subprojects, directs the deployment and organization of resources, including the mentoring of project coordinators and project managers. Ensure development of timetables and targets and check progress against them. Direct the plans of activities; ensures a plan which streamlines the program process.

14. Meet with stakeholders and executive to review solution and issues and to gain commitment on recommendations related to quality payment programs.

15. Exhibits mastery of reporting projects, data manipulation and analysis related to quality payment programs. Provides mentorship.

16. Direct project managers to use the commonalities/differences within the team members’ goals, values and problem-solving styles to generate multiple alternatives in leading group to achieve a result and monitor for effectiveness. Ensure program impact does not negatively impact or interfere with others.

  • Director, Payer Quality Performance

    4 weeks ago

    Linthicum Heights, United States University of Maryland Medical System Full time

    Job DescriptionJob DescriptionCompany DescriptionThe University of Maryland Medical System is a 14-hospital system with academic, community and specialty medical services reaching every part of Maryland and beyond. UMMS is a national and regional referral center for trauma, cancer care, Neurocare, cardiac care, women’s and children’s health and physical...

  • AR Specialist

    4 weeks ago

    Linthicum Heights, Maryland, United States Anne Arundel Dermatology Full time

    Overview: At Anne Arundel Dermatology we give exceptional care - to our patients and to eachother.  Patient First | Caring | Accountability | Trust | One Team | Growth   Founded 50+ years ago with a mission to provide the highest quality and full spectrum of medical, surgical, and esthetic skin care services to each and every one of its patients, Anne...

  • Director of Financial Planning

    2 weeks ago

    Linthicum Heights, Maryland, United States Anne Arundel Dermatology Full time

    Overview: At Anne Arundel Dermatology we give exceptional care - to our patients and to eachother.  Patient First | Caring | Accountability | Trust | One Team | Growth   Founded 50+ years ago with a mission to provide the highest quality and full spectrum of medical, surgical, and esthetic skin care services to each and every one of its patients, Anne...

  • Director of Accounting

    7 days ago

    Linthicum Heights, Maryland, United States Anne Arundel Dermatology Full time

    Overview: At Anne Arundel Dermatology we give exceptional care - to our patients and to eachother.  Patient First | Caring | Accountability | Trust | One Team | Growth   Founded 50+ years ago with a mission to provide the highest quality and full spectrum of medical, surgical, and esthetic skin care services to each and every one of its patients, Anne...

  • Intern, Finance

    4 weeks ago

    Linthicum, Maryland, United States University of Maryland Medical System Full time

    Job Description General Summary  A college intern working in the field of healthcare finance helps in the development and implementation of UMMS policies and practices in a designated area such as for reimbursement, regulatory policy, billing compliance, financial management, budgeting, accounting, etc. By getting hands-on experience by working under a...

  • AR Specialist

    6 days ago

    Linthicum Heights, United States Anne Arundel Dermatology Full time

    Overview: At Anne Arundel Dermatology we give exceptional care - to our patients and to eachother. Patient First | Caring | Accountability | Trust | One Team | Growth Founded 50+ years ago with a mission to provide the highest quality and full spectrum of medical, surgical, and esthetic skin care services to each and every one of its patients, Anne Arundel...

  • Director of Finance

    4 weeks ago

    Linthicum Heights, United States Latitude, Inc. Full time

    Job DescriptionJob DescriptionDirector of FinanceMain PointsOnsite Linthicum Heights, MD Must have Manufacturing experience Must have 10+ years of experienceMust have Bachelors DegreeSalary:160k-195k depending on experienceRole DescriptionThis is a full-time Director of Finance role based in Linthicum Heights, MD. The Director  of Finance will oversee all...

  • RN Regional Director of Clinical Operations

    1 week ago

    Linthicum Heights, United States CommuniCare Corporate Full time

    *RN Regional Director of Clinical Operations**CommuniCare Health Services* is currently recruiting an experienced and dynamic Registered Nurse, BSN preferred, for the position of *Regional Director of Clinical Operations. This position covers our facilities in the state of Maryland. *The ideal candidate will have 3 - 5 years of experience in Nursing...

  • Refund Specialist

    7 days ago

    Linthicum Heights, Maryland, United States Concentra Career Choice Full time

    Overview: Please be advised, if you are viewing this position on Indeed, that the salary rate/range set forth herein was provided by Indeed. Concentra's market specific rate/range will be provided during the interview process. JOB SUMMARY:    Under indirect supervision, performs a variety of tasks researching refund requests, overpayments, credit...

  • AR Representaive

    3 weeks ago

    Linthicum Heights, Maryland, United States University of Maryland Medical System Full time

    Job Description This is a hybrid position with some days required onsite in Linthicum.  General Summary Under general supervision, evaluates financial responsibility of patients, updates accounts to a billable/collectible status, research all possible means to resolve accounts, contacts patients, insurance companies and other departments regarding...

  • Organization Development

    2 weeks ago

    Linthicum Heights, Maryland, United States University of Maryland Medical System Full time

    Job Description General Summary   Under limited supervision delivers organization development, organizational learning, and inclusion services for the Medical System.  Principal Responsibilities and Tasks The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. ...

  • Registered Nurse

    3 weeks ago

    Linthicum Heights, United States CommuniCare Corporate Full time

    CommuniCare Corporate - RN Regional Director of Clinical OperationsCommuniCare Health Services is currently recruiting an experienced and dynamic Registered Nurse, BSN preferred, for the position of Regional Director of Clinical Operations. This position covers our facilities in the state of Maryland. The ideal candidate will have 3 - 5 years of...

  • Intern, Finance

    3 weeks ago

    Linthicum Heights, United States University of Maryland Medical System Full time

    Job DescriptionJob DescriptionCompany DescriptionRenowned as the academic flagship of the University of Maryland Medical System, our Magnet®-designated facility is a nationally recognized, academic medical center with opportunities across the continuum of care.  Come join UMMC and discover the atmosphere where talents and ideas come together to enhance...

  • Intern, Finance

    3 weeks ago

    Linthicum Heights, Maryland, United States University of Maryland Medical System Full time

    Job Description General Summary A college intern working in the field of healthcare finance helps in the development and implementation of UMMS policies and practices in a designated area such as for reimbursement, regulatory policy, billing compliance, financial management, budgeting, accounting, etc. By getting hands-on experience by working under a...

  • Corporate Compliance Education and Training Analyst, Hybrid

    4 weeks ago

    Linthicum Heights, Maryland, United States University of Maryland Medical System Full time

    Job Description Under the supervision of the Director of Compliance for Education, Training, & Regulatory Monitoring, the analyst will assist with the management, development, implementation and monitoring processes to ensure compliance with federal and state laws and regulations affecting the University of Maryland Medical System (UMMS) and its Member...

  • Refund Specialist

    7 days ago

    Linthicum Heights, Maryland, United States Concentra Full time

    Overview: Please be advised, if you are viewing this position on Indeed, that the salary rate/range set forth herein was provided by Indeed. Concentra's market specific rate/range will be provided during the interview process. JOB SUMMARY:    Under indirect supervision, performs a variety of tasks researching refund requests, overpayments, credit...

  • Intern, Finance

    4 days ago

    Linthicum Heights, United States University of Maryland Medical System Full time

    Job DescriptionJob DescriptionCompany DescriptionRenowned as the academic flagship of the University of Maryland Medical System, our Magnet®-designated facility is a nationally recognized, academic medical center with opportunities across the continuum of care.  Come join UMMC and discover the atmosphere where talents and ideas come together to enhance...

  • Director Case Management

    4 weeks ago

    Towson, Maryland, United States UMMS Executive Search Full time

    Job Description General Summary  The Director’s primary responsibilities include management of all case management from pre-admission through post-discharge associated with the University of Maryland, St. Joseph Medical Center inpatient units, specialty outpatient units and emergency department. This position has responsibility for daily operations...

  • Director of Revenue Cycle Management

    4 weeks ago

    Owings Mills, Maryland, United States CTTX Health Full time

    Director of Revenue Cycle Management (RCM) CTTX Health is seeking a highly skilled and results-driven Director of Revenue Cycle Management (RCM) to lead our revenue cycle operations. As the Director of RCM, you will be responsible for overseeing the revenue cycle process, ensuring accurate and timely billing, maximizing revenue collection, and optimizing...

  • Registered Respiratory Therapist, PRN, Nights, Staffing Center

    4 weeks ago

    Linthicum Heights, Maryland, United States University of Maryland Medical System Full time

    Job Description General Summary A Registered Respiratory Therapist (RRT), under medical direction, provides treatment, management, diagnostic evaluation, and care of patients with deficiencies and abnormalities of the Pulmonary System. The RRT assesses patient who require respiratory care by interview, physical examination of the chest and review of the...