Company: MDX Hawaii
Job Location: Hawaii (Hybrid - Remote & In-Office)
Pay Range: $107,550 - $131,800 per year
This salary range is a guideline. Individual compensation can vary based on factors unique to each candidate, such as skill set, experience and qualifications.
Position Summary: Under the direction of the Sr. Manager, Quality Programs, the Supervisor is responsible for providing first line supervision for the Quality Programs staff. Supervisor responsibilities include but are not limited to daily supervision and monitoring of staff productivity and performance. This position involves leading and/or participating in process improvement projects supporting the work needed to meet department and company goals. The Supervisor will work collaboratively with internal and external partners to develop or improve systems, processes and tools. The Supervisor will assist the Sr. Manager, Quality Programs in developing tactics to meet program goals and metrics.
The clinical supervisor will supervise any clinical staff in the role of Quality, e.g. nurses, pharmacists, etc. and may also supervise non-clinical staff. Additional tasks will include managing the oversight of HEDIS diabetic and clinical HEDIS measures. The supervisor will work closely with the MDX Sr. Manager of Pharmacy on any part D HEDIS measures requiring QPP assistance. Specific patient outreach related to the HEDIS Diabetes measures will be funneled through this position.
Essential Job Functions:
- Responsible for team assignments, workload, and performance management.
- Monitors team performance metrics, ensuring that performance targets are met or exceeded.
- In collaboration with the Sr. Manager, Quality Programs leads efforts to analyze the company’s performance data and operationalize efforts for improvement if identified.
- Assists with the selection, hiring, and onboarding of all new Quality Program team members.
- Oversees the onboarding of any new providers or practices that join the market.
- Supports the Sr. Manager, Quality Programs in vendor management and coordination.
- Assists and supports the Sr. Manager, Quality Programs on projects as needed.
- Depending on area of assignment, will draw upon clinical/professional training and knowledge to carry out responsibilities (e.g. HEDIS/Quality RN)
- Participates in all QM audits including Health Plan HEDIS audits, Compliance audits, etc.
- Leads HEDIS reporting and works with QPP Analyst on duties including but not limited to:
- Coordinating and submitting records to the health plan for HEDIS chases;
- Maintaining HEDIS member exclusion data;
- Training staff regarding measures (clinical portion);
- Working with supplemental data sources such as lab vendors and HHIE to ensure appropriate diabetic codes are submitted.
- All other duties as assigned.
Required Qualifications:
- Minimum Experience
- Must exhibit knowledge of medical records and analysis of processes of clinical care in addition to exhibiting knowledge of familiarity with HEDIS/STAR measures and standards.
- 2+ years of experience in managed care or the health care industry.
- 1+ years supervisory experience.
- Experience with Program Management.
- Experience with Value Based Care including Risk Adjustment, Quality/STARs, or Medical Experience preferred.
- Education/Licensure:
- RN license or BSN preferred. Other clinical licensure with at least three (3) years practice in a health care setting preferred.
- Certified Coder preferred. CRC preferred.
- Current valid Hawaii State Driver’s license and Proof of Hawaii No-Fault Auto insurance. Clean driving record as evidenced by a recent driver’s abstract.
Travel: Position is Hybrid with Remote and In-Office requirements. May require travel via own vehicle to provider offices and may require travel to Neighbor Islands.
Skills and Abilities:
- Ability to be a team player and exercise initiative in responding to provider requests and concerns in a helpful and courteous manner.
- Provider contracting and customer service techniques.
- Ability to influence change across teams (both internal & external).
- General understanding of the health care industry, ideally the provider relations field-desired.
- Excellent interpersonal and telephone communication skills are required.
- Exercise attention to detail.
- Ability to work under pressure with minimal supervision, multi-task, complete projects in a timely fashion and meet deadlines a must.
- Excellent analytical, problem solving and organizational skills a must.
- Language Skills: Strong communication skills both written and verbal to work with multiple internal and external clients in a fast-paced environment.
- Mathematical Skills: