Manager-Quality Improvement Abstraction

Overview

Now hiring a Manager Quality Improvement Abstraction!

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This position is directly responsible for the successful growth, implementation and ongoing management of Medical Record Retrieval, Review and Reporting processes to support HEDIS, STARs, HEDIS Like, supplemental, and other required regulatory reporting as well as PHP Board approved health management initiatives across the enterprise. The position will assist the Director of Performance Improvement in ongoing management and growth of Abstraction programs and act as a key resource for provider relations and education with an emphasis on HEDIS abstraction. This position requires an ability to work effectively within a complex organization across multiple departments to drive results. Training and business development skills are desirable as well as experience with NCQA, CMS, HEDIS, and MA STARs. Role will have responsibility for clinical interpretation of medical documentation, training, and over reading clinical charts.

How you belong matters here.

We value our employees' differences and find strength in the diversity of our team and community.

At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

Why Join Us

• Full Time - Exempt: Yes

• Job is based Rev Hugh Cooper Admin Center (Remote-Eligible for New Mexico residents only)

• Work hours: Days

• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.

Ideal Candidate:

Minimum of two years direct experience building, developing, coaching and mentoring teams across multiple disciplines4 years of HEDIS and/or healthcare experience OR NCQA, JCAHO, CMS accreditation experience

Skills in managing, supervising, and training staff.Skills in operational management Skills in developing and maintaining working relationships with outside agencies, executive management, employees and the general public.Experience with electronic health record (EHR) systems.

Qualifications

Bachelors Degree required. 6 years of additional experience can be substituted in lieu of degree

Preferred:Masters degree in Business, Nursing, Healthcare, or related field Registered Nurse (RN) with minimum 4 years clinical experience, Knowledge of medical terminology, knowledge of standard medical practices, medical assistant, medical coding or data management experience

Knowledge of Microsoft Applications, including Excel and Access

Responsibilities

• Work with leadership to increase collaboration around HEDIS Medical Record collection and abstraction both internally and externally

• Develop and maintain positive relationships with PMG and external network physicians and staff

• Identify areas of opportunity for partnership between providers and PHP

• Develop and perform training (internal and external) for abstraction programs

• Serves as resource regarding record retrieval and abstraction and recommends process modifications and practice changes to improve efficiency, effectiveness, and reliability of clinical processes and systems

• Promotes PHS system-wide strategies and compliance with PHS policies and standards, adopted accreditation standards and federal/state regulator requirements

• Analyzes and communicates results of programs, suggests future changes to drive improvement, and lead change management throughout execution

• Negotiate contracts using performance-based contracting techniques and strategies that support corporate business decisions.

• Responding to RFP/RFIs and other regulatory requirements ex: NCQA, HSD reporting

Quarterly program reporting to Director Other reporting as needed

• Perform other duties as assigned.

Benefits

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian? As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

Inclusion and Diversity Our culture is one of knowing and respecting our patients, members, and each other. We capture this in our Promise and CARES commitments.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

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Maximum Offer for this position is up to

USD $47.83/Hr.

Compensation Disclaimer

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.