Regional Director of Quality presso Caraday Management LLC

Description

JOB TITLE: Regional Director of Quality 

JOB CODE: 79 

DEPARTMENT: ADMINISTRATIVE 

FLSA STATUS: EXEMPT 

REPORTS TO: VP of REIMBURSEMENT 

JOB SUMMARY: Responsible for the executive oversight of the administration, clinical planning, development, and operations of the Quality & Reimbursement program. This position supports regional and facility employees in all aspects of Care Management. 

ESSENTIAL FUNCTIONS: 

• Responsible for the overall management, compliance, leadership, growth, and profitability of assigned programs within the division, including PBJ and QIPP. 
• Manages, monitors, and supports all operational, administrative, clinical, and fiscal activities of assigned programs and services to ensure quality and consistency with company standards. This includes education and training of all community team members, as needed. 
• Provides support to teams for medical review, managed care authorizations (primary part B), clinical reimbursement strategies, systems implementation, training, and team development 
• Supports the development and compliance of quality outcomes and RAI systems using various supporting technological applications to ensure an appropriate level of resident care and timely reimbursement of the care provided. 
• Uses standardized reports that include analysis and opportunity for discussion, strategizing, planning, implementation, monitoring, and action planning. 
• Develops and implements training strategies with the Interdisciplinary Field Support for all payor types including PPS, Managed Care and State Medicaid Case Mix Reimbursement. 
• Develops, implements, monitors, and promotes care management systems, models, services, processes and tools at all levels of the organization to assure delivery of quality of care to residents. 
• Participates in CMS and State initiatives as related to nursing facility value, quality, and reimbursement systems. 
• Responsible for ensuring that the quality and appropriateness of patient care meets or exceeds company and industry standards and ensures that all services are in compliance with state and federal legal, regulatory, accreditation and reimbursement guidelines. 
• Assists with the development of corrective actions, best practices and/or education to appropriate employees. 
• Conducts community and/or region visits as needed to identify strengths and opportunities. 
• Develops and provides information to identify trends, variances, practice patterns and opportunities for improvement as part of the QAPI process to promote positive outcomes. 
• Assists in the development of annual budgets and program aspects related to staff enhancement. 
• Completes required forms and documents in accordance with company policy and state and/or federal regulations. 
• Performs other duties as assigned. 

Requirements

QUALIFICATIONS: 

Required 

• Graduate of accredited school of Therapy or Nursing with at least a bachelor’s degree. 
• Holds a current license to practice as an OT, PT, SLP, LVN or RN 
• Five (5) years health care management in long-term care organizations. Preferred: three (3) years’ experience managing region or division level positions. 
• ? Knowledge of state and federal regulations, both clinical and financial, as it relates to Quality programs, RAI process, and reimbursement systems. 
• Proficient in the use of Microsoft office products. 
• Frequent travel throughout Texas. 
• Ability to oversee PBJ, QIPP, ADR/medical review process. 
• Ability to work with a sense of urgency to complete tasks. 

PHYSICAL REQUIREMENTS: The ability to safely perform movements such as pushing, pulling, lifting, bending, kneeling, and reaching up to 50 pounds with or without reasonable accommodations 

WORK SCHEDULE: As assigned, including some weekends, evenings and holidays 

WORK ENVIRONMENT: Clinical 

Caraday Healthcare provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, genetics, or any other characteristic protected by law.