Manager of Quality - MSSP

About us:

HEART. It is the driving force of our commitment to serving others with empathy, respect, and dignity. CareMax, is committed to providing the best that medicine has to offer with quality healthcare for those who need it most, our seniors. Join our team and experience it for yourself. We are Health with Heart. 

You can count on us to provide you with resources and opportunities for growth, while contributing to our mission to improve lives through kindness, compassion, and better health. This is what we offer:

• Access to continual education through CareMax University 
• Starting with 18 days of Paid Time Off 
• 8 company paid holidays plus a floating holiday 
• 401(k) plan with company match 
• Comprehensive medical package 

About you:  

*Must have experience with MSSP* 

The Quality Manager directly contributes to reach the organization’s quality goals working with all patients from all health plans and LOBs. The Manager is responsible for coordinating and implementing the HEDIS and STAR's data collection, supporting the Medicare Shared Savings Program (MSSP), and works under the leadership of the Quality Improvement Director to develop strategies for achieving performance goals for both programs. This role assists with quality data tracking and reports preparation to efficiently and effectively achieve CareMax performance goals. The Quality Manager may supervise a team of nonclinical staff who promotes and facilitates that the CareMax patients complete needed preventive as well as management tests and procedures, perform medical record review and process electronic data entry submissions. Provides direction and support to the Supplemental Data Entry team using routine communication to promote standard work processes. Acts as knowledge expert for continuous quality improvement activities, educating CareMax as well as practices staff. Assist with oversight and implementation of CareMax workflow processes and internal controls. 

Qualifications and Skills

• Minimum 3 years of HEDIS/Quality experience with acquired progressive responsibility. Strong leadership and organization skills with the ability to achieve priorities, measurements, and strategic goals with limited/minimal supervision. Basic understanding of quality improvement standards such as NCQA, HEDIS, CAHPS, HOS and CMS 
• At least 2 years’ experience in managing and monitoring continuous improvement activities and/or projects, including and not limited to tracking key performance indicators. 
• Proficient knowledge of computers and typical production software (e.g., MS Office, Outlook, Word, Excel, PowerPoint, etc.). 
• Experience and proficiency with different Electronic Medical Records 
• Position may require traveling, including and not limited to driving between site locations throughout assigned states and locations. 
• Ability to supervise staff working at multiple sites throughout the organization. 
• Ability to be a strong leader, build relationships with staff and physicians 
• An energetic, ambitious and dynamic personality. 

Essential Duties and Responsibilities 

• Direct supervision of employees that may include disciplinary authority 
• Provides leadership, support and training updates for staff that perform medical record review and data entry. Processes submitted data and information by providers for the capture of quality measure performance. 
• Assists with program strategy and planning. 
• Provides quality analytic support to cross functional departments through creation and development of program, practice and provider level reports
• Collaborates with provider clinic staff to execute the proper submission of medical records and data based on current HEDIS technical specifications. 
• Collaborates with the Corporate Quality Director in the development of training resources on STAR/HEDIS/MSSP Quality measures, to support proper collection of STAR/HEDIS/MSSP data. 
• Performs various quality department functions and processes, such as quality of care complaint/adverse event review, and assessment of medical record review results and recommend actions to address any identified improvement opportunities.
• Participates in new hiring actions and on-boarding requirements for staff 
• Gathers and processes information needed to complete insurance claims and reimbursements; submits accurate electronic and/or hard copy claims to various payers 
• Assists in the coordination of flow of information between coding and other departments including Medical Records, Administration, Physicians and Medical Audits
• Support the patient experience improvement interventions to make sure CareMax performs at 4 to 5 stars for all health plans 
• Perform other related duties as required or requested. 

Come join the CareMax family and be part of Health with Heart. Help us continue to change lives every day!

CareMax provides equal employment opportunity to all applicants and employees. No person is to be discriminated against in any aspect of the employment relationship due to race, religion, color, sex, age, national origin, disability status, genetics, citizenship status, marital status, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws