Director, Clinical Quality, Training, Oversight and Innovation

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 Director, Clinical Quality, Training, Oversight and Innovation is engaged in defining and executing the overall clinical quality strategy and direction of the organization pertaining to data abstraction from medical records in any format for all Inovalon products. In addition, this position leads the design and execution of all clinical training and quality oversight for data abstraction for the organization and its vendors internationally. The position provides clinical direction to the Product, Operations, Client Services, and Innovation teams and drives clinical collaboration across these teams on a national level.

Duties and Responsibilities:

• Develop and maintain an expert level of knowledge regarding products, services, capabilities, infrastructure, and operations of Employer and its affiliates, the marketplace, competition, strategic positioning, threats and direction to achieve optimal insight and success with respect to Employer’s (and those of its affiliates) products, services, capabilities, support, functionality requirements, and financial performance.


• Lead, drive, and ultimately be responsible for planning, implementation, execution, and successful achievement of the overall clinical quality strategy and direction of the organization pertaining to data abstraction from medical records, and the design and execution of all clinical training and quality oversight for data abstraction for the organization and its vendors internationally, including:


• Serve as subject matter expert for risk-adjustment and HEDIS for the company, engaging frequently in client services functions as well as business development and marketing. Serve as an internal resource to drive and maintain Inovalon’s thought leadership in the RA and HEDIS industry. Participate in industry conferences as an expert presenter.


• Responsible for training all internal staff, partners, and vendors internationally on accurate medical data abstraction (for all products, including RA and HEDIS) in compliance with all coding and regulatory requirements. This includes initial development and annual updates of all training materials annually or more frequently as appropriate.


• Responsible (in collaboration with MRR Operations leadership) for quality oversight of all internal staff, partners, and vendors internationally in the performance of medical data abstraction (for all products, including RA and HEDIS), in compliance with all regulatory requirements. This includes identifying opportunity and driving execution of quality pullback processes and driving tool upgrades as warranted.


• Responsible for execution of all Joint Quality Audit processes across RA and HEDIS clients, including promoting appropriate contractual language as permitted by Product leads. This requires significant client interaction with promotion of Inovalon’s best-in-class review process as well as representation of Inovalon’s position/performance in the context of third-party audits and other client-specific projects.


• Serve as clinical expert in development/improvement of all tools/systems related to medical data abstraction.


• Serve as clinical liaison to the Innovation team, collaborating to drive development and promotion of new market capabilities in the context of data abstraction (such as NLP). In addition, this position assists the Innovation team in performing its due diligence around onboarding new EMR partners to ensure CDE meets all clinical and regulatory requirements for use by Inovalon and its clients.


• Responsible (in collaboration with relevant teams, such as Innovation) for design and execution of clinical quality oversight processes for ensuring clinical and regulatory validity of records received through EMR interoperability capabilities.


• Maintain compliance with lnovalon's policies, procedures and mission statement.


• Adhere to all confidentiality and HIPAA requirements as outlined within lnovalon'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.


• Fulfill those responsibilities and/or duties that may be reasonably provided by lnovalon for the purpose of achieving operational and financial success of the Company.


• Uphold responsibilities relative to the separation of duties for applicable processes and procedures within your job function.


• We reserve the right to change this job description from time to time as business needs dictate and will provide notice of such.

Education:

• 
  
  
  
  • Bachelor’s Degree in Arts/Sciences (B.A./B.S.) preferred and
  
  
  • Active RN license required
  
  
  
  

Experience:

• Active RN license required with a minimum of 12+ years of relevant overall experience, and 6 years high level management experience, preferably in a Director level or higher role required


• Minimum of 5 years’ experience in quality and/or compliance required


• Minimum of 5 years’ experience in medical coding required


• Minimum of 5 years’ experience with adult learning/training required

Skills and Abilities:

• Outstanding attention to detail with the ability to set priorities and work on multiple tasks simultaneously;


• Strong computer skills required, specifically with Microsoft Office and data collections tools;


• Ability to manage and meet deadlines;


• Strong interpersonal skills; and


• Professionally skilled in verbal and written communication.

Working Conditions and Physical Demands:

• This is a primarily sedentary role. The employee is regularly required to sit, talk, and hear for extended periods of time, and also required to repetitively use manual labor to operate a computer keyboard and other office equipment.


• The employee may occasionally need to stand, walk, or lift and/or move up to 10 pounds. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.