The Director of Clinical Quality reports to the Vice President of Clinical Quality. The Director ofClinical Quality is responsible for direct involvement, chart reviews, IDG attendance and oversight ofcorrections needed. This role evaluates needs in the individual branch and establishes a plan toimplement changes and overall improvement of documentation. This role helps develop a process ofaccountability to ensure improvement of overall quality. The Director of Clinical Quality will develop,when applicable, and direct the implementation of corrective action plans in branches as a result ofunfavorable internal survey or external conditional survey outcomes.
Essential Functions Upon initiation of a CMS audit which may include Targeted Probe and Educate, UPIC, SMRC and/or any other audit activity, the Director of Clinical Quality along with the VP of ClinicalQuality will analyze the office risk level and develop an action plan. This will include but notlimited to education, audit initiation, interdisciplinary group review, calls to assist virtually and/orpossible on-site visits.On-going assessment of the branch will be provided on a regular basis and weekly reports to theVP of Clinical Quality will be provided to analyze outcomes and possible changes in plan.Aids with claim denials and in the resolution of claims.Collaboration with the Director of Clinical Operations and Vice President of Clinical Operationswould be maintained to ensure coordination is maintained and delineate roles and responsibilitiesrelated to support and education actions.Ensures compliance with local, state and federal regulations and accreditation standards. Providessupport, direction and feedback to staff during the clinical compliance process. May delegateresponsibilities to ensure follow-up to resolution of each action item identified.Proactively assesses office performance and implements changes to prevent noncompliance. Communicates with up line manager, Chief Clinical Officer, Chief Compliance Officer, legaldepartment, Utilization Management and other corporate resources as appropriate toaddress/resolve issues.May work as support or back up to a Director of Clinical Operations at times when increasedsurvey response is needed. This role would be a resource to help manage and contribute whenappropriate.Direct and monitor resolution of identified deficiencies in conditional surveys.Support offices with quality measures in all areas which may include but not limited to claimdenials, quality metrics, quality reviews and quality care. About YouSpecialized Knowledge/Skills:
Extensive knowledge in the areas of documentation, and the interpretation and application ofregulations and performance improvement standards required.Must be knowledgeable of federal, state, and local regulations, as well as federal guidelines forhospice services. Knowledgeable in OSHA regulations.Experience building and leading high-performing teams; mentoring team membersConfident presenter and persuasive speaker.Ability to communicate effectively; excellentinterpersonal skills.Ability to manage multiple projects and meet deadlines. Strong follow up skillsExercises professional judgement and demonstrates excellent problem resolution skillsExperience with Lean Six Sigma (LSS) tools and methodologies preferred.Strong attention to details.
Education/Experience:
Bachelor’s or advanced degree in NursingMinimum of 5-years experience in nursing, 3 in hospice and 2 of which have been in amanagement role for a certified agency preferredLicense/Certification:Valid driver’s license and auto liability insurance coverageUnencumbered and active RN license in state of residence required if RN.
Training/Equipment
Benefits for All Associates (Full-Time & Per Diem):
Competitive Pay401(k) with Company MatchCareer Advancement OpportunitiesNational & Local Recognition ProgramsTeammate Assistance Fund
Additional Full-Time Benefits:
Medical, Dental, Vision InsuranceGenerous Paid Time Off + 7 Paid HolidaysWellness Programs (Telemedicine, Diabetes Management, Joint & Spine Concierge Care)Education Support & Tuition AssistanceCompany-paid Life & Long-Term Disability InsuranceVoluntary Benefits (Pet, Critical Illness, Accident, LTC) Legalese This is a safety-sensitive positionEmployee must meet minimum requirements to be eligible for benefitsWhere applicable, employee must meet state specific requirementsWe are proud to be an EEO employerWe maintain a drug-free workplace Location Gentiva Our CompanyAt Gentiva, it is our privilege to offer compassionate care in the comfort of wherever our patients call home. We are a national leader in hospice care, palliative care, home health care, and advanced illness management, with nearly 600 locations and thousands of dedicated clinicians across 38 states.
Our place is by the side of those who need us – from helping people recover from illness, injury, or surgery in the comfort of their homes to guiding patients and their families through the physical, emotional, and spiritual effects of a serious illness or terminal diagnosis.
Our nationwide reach is powered by a family of trusted brands that include:
Hospice care: Gentiva Hospice, Emerald Coast Hospice Care, Heartland Hospice, Hospice Plus, New Century Hospice, Regency SouthernCare, SouthernCare Hospice Services, SouthernCare New BeaconPalliative care: Empatia Palliative Care, Emerald Coast Palliative CareHome health care: Heartland Home HealthAdvanced illness management: Illumia Health
With corporate headquarters in Atlanta, Georgia, and providers delivering care across the U.S., we are proud to offer rewarding careers in a collaborative environment where inspiring achievements are recognized – and kindness is celebrated.
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