Manager, Clinical Quality Operations

Inovalon was founded in 1998 on the belief that technology, and data specifically, would empower the transformation of the entire healthcare ecosystem for the better, improving both outcomes and economics. At Inovalon, we believe that when our customers are successful in their missions, healthcare improves. Therefore, we focus on empowering them with data-driven solutions. And the momentum is building.

Together, as ONE Inovalon, we are a united force delivering solutions that address healthcare’s greatest needs. Through our mission-based culture of inclusion and innovation, our organization brings value not just to our customers, but to the millions of patients and members they serve.

Overview: The Manager, Clinical Operations will be responsible for field oversight of our in-home assessment Nurse Practitioner and Physician Assistants. The focus of this role is on the day to day delivery of excellence in the quality of care, ensuring all clinical and operational policies and procedures are followed and production targets are met.

Duties and Responsibilities:

• Manage large network of field-based mid-level practitioners;
• Partner with department leaders in strategic planning and review of dashboards and reporting to drive operational excellence;

• Conduct 1:1 check ins with your providers at least twice a month to include a review of their current performance and any necessary coaching;
• Review the results of audits of medical records performed by the Clinical Auditor;
• Review clinical monitoring reports for trends or individual issues;
• Develop/Review the clinical resource scorecard that summarizes the results of audits, clinical monitoring and operational monitoring reports for trends and individual issues;
• Provide specific one-on-one coaching on quality issues identified in review of the clinical resource’s audit results;

• Identify clinical resources requiring referral to a remediation training course;
• Identify clinical resources whose performance warrants referrals for a Quality Improvement Program;
• Assume role of clinical resource when questions arise in the field;
• Prepares documentation tracking coaching efforts and results of coaching efforts;
• In conjunction with the clinical training team, identify training needs, contributes to training material development, and support its implementation;

• Participate in key organizational meetings providing details specific to audit activity and outcomes;
• Maintain compliance with ComplexCare Solution's policies, procedures and mission statement;
• Adhere to all confidentiality and HIPAA requirements as outlined within ComplexCare Solution's Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position; and
• Fulfill those responsibilities and/or duties that may be reasonably provided by ComplexCare Solutions for the purpose of achieving operational and financial success of the Employer.

Job Requirements:

• Minimum of 5 years of management experience desired with an interest in Healthcare Field and Career;
• Goal oriented, results focused and self-motivated;
• A self-starter; ability to work in a Team Environment;
• Ability to create a positive and motivating work environment;

• Excellent written and oral communication skills;
• Ability to organize his/her time and work without direct and daily supervision;
• Strong interpersonal and organizational skills;
• Ability to work in a fast-paced environment and prioritize tasks to meet deadlines and goals.  
• Knowledge of Microsoft Office Products, particularly Outlook and Excel; and

• Ability to exercise independent judgment within policy and procedure guidelines established by the company.

Education:

• Bachelor’s Degree;
• Must be have current license and credentials as RN or LPN; and
• Coding knowledge (CPC preferred, but not required).

Physical Demands and Work Environment:

• Sedentary work (i.e. sitting for long periods of time);
• Exerting up to 10 pounds of force occasionally and/or negligible amount of force;
• Frequently or constantly to lift, carry push, pull or otherwise move objects and repetitive motions;

• Subject to inside environmental conditions; and
• Travel for this position will include less than 5% locally usually for training purposes.

The actual base pay offered may vary depending on multiple factors including, but not limited to, job-related knowledge/skills, experience, business needs, geographical location, and internal equity. At Inovalon, it is not typical for an individual to be hired at or near the top end of the range for their role, and compensation decisions are dependent upon the facts and circumstances of each position and candidate.

Studies have shown that women and people of color are less likely to apply for jobs unless they believe they meet every one of the qualifications listed in a job description. If you don’t meet every qualification listed but are excited about our mission and the work described, we encourage you to apply regardless. Inovalon is most interested in finding the best candidate for the job and you may be just the right person for this or other roles.

By embracing diversity, equity and inclusion we enhance our work environment and drive business success. Inovalon strives to reflect the diversity of the communities where we operate and of our clients and everyone whom we serve. We endeavor to create a culture of inclusion in which our associates feel empowered to bring their full, authentic selves to work and pursue their professional goals in an equitable setting. We understand that by fostering this type of culture, and welcoming different perspectives, we generate innovation and growth.

Inovalon is proud to be an equal opportunity workplace and is an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status. We also consider qualified applicants regardless of criminal histories, consistent with legal requirement.

The Company maintains a drug free work environment for all of its associates, which includes employees, contractors and vendors. It is unlawful for associates to manufacture, sell, distribute, dispense, possess or use any controlled substance or marijuana in the workplace and doing so will result in disciplinary action, up to and including termination of employment or the contracted relationship.

To review the legal requirements, including all labor law posters, please visit this link