Program Manager - Core Measure Abstraction, Quality Data Services

Employer
200 N Keene Street Columbia, MO, United States
573-817-8300, ext 182
http://primaris.org/join-our-team/
Job Summary
col-narrow
License: RN - Registered Nurse
Specialty: General
Location: Remote, MO
Employment Type: Full time
Job Description
col-wide
Summary
 
This position has primary responsibility for the day-to-day operations for Core Measures Abstraction services within the Primaris Quality Data Services Department.
 
Essential Duties and Responsibilities include the following. Other duties may be assigned.
 
Oversees contract Core Measure Abstraction services on a day-to-day basis to meet contract requirements within budgetary constraints.  Work in conjunction with Project Leads to monitor compliance with all contract requirements related to abstraction.
 
Perform Core Measure abstraction as described in the Core Measure Abstractor job description as required to ensure meeting contract requirements. Assist Project Leads in determining work assignments for per diem staff to ensure contract requirements are met and productivity of salaried staff is maintained.
 
Participates in regular conference calls, as required by each client.  Helps guide discussion to address abstraction concerns or issues, documentation issues, record completion, and other issues directly related to abstraction of data.  In conjunction with Project Lead, arranges/coordinates additional conference calls or Webex to resolve specific issues related to abstraction, documentation, reporting or other concerns, as indicated.
 
Provides reports and information to the organization as specified in the contract or as requested by the client in an effective and timely manner.  Uses feedback from the organization to improve reports.
 
Monitors compliance with contract requirements for record completion according to established deadlines, using daily tracking log or other tools as appropriate for the services being provided.  Reviews tracking logs maintained by Project Leads.  Works with the Project Lead in developing and implementing action plans as required to ensure record completion deadlines are met.
 
Maintains regular contact with all Project Leads and abstractors.  Assigns measures to abstractors in conjunction with Project Lead, according to their training/skill level.    Serves as resource to Project Leads and abstractors to resolve issues related to abstraction, criteria interpretation, documentation, and work performance.  Submits recommendations or questions from Primaris abstractors to the client for consideration and/or resolution or works with Project Leads to submit recommendations.  Provides follow-up to abstractors related to conference calls and other issue resolution.
 
Serves as a resource to the organization regarding current Core Measure criteria, as well as changes in Core Measures anticipated in the future.  Provides recommendations and resources that might be beneficial to organization in improving Core Measure performance based on information obtained from abstraction and other resources.
 
Develops and maintains a strong working relationship with the primary contacts at each organization.  Works collaboratively with the organization to resolve issues.
 
Identifies need for additional education or training for Primaris abstractors and/or organization/contract staff.  Works with Director of Quality Data Services to develop and implement training programs to ensure Primaris Quality Data Services Core Measure Abstraction staff maintain current and complete knowledge of the abstraction rules and guidelines.
 
Conducts/reviews inter-rater reliability (IRR) reviews on all Core Measure Abstractors on a quarterly basis, including Project Leads. Provides documented feedback to each abstractor and recommends/provides additional education/training for abstractors when a pattern or trend is identified through IRR reviews. Monitors Project Lead response and application of feedback into current abstraction processes.  Works in conjunction with Project Leads to monitor abstractor response and application of feedback. 
 
Receives and applies feedback from IRR conducted on own work by Project Lead or other abstractors.
 
Maintains current knowledge of all applicable federal and state laws and regulations as well as individual contract requirements.
 
Develops and coordinates project management tasks including planning, implementation budget, and staffing for maintenance of contract requirements with clients. Provides ongoing feedback to client during new contract implementation through use of a written project plan.
 
Provides detailed variance reports, with recommendations for possible action plans to clients based on abstraction findings, trends, or patterns.  Identifies and reports patterns/trends by measure, provider, and department/unit, when possible.
 
Develops and maintains a strong working relationship with the primary contacts at each organization.  Works collaboratively with the organization to resolve issues in a timely and effective manner.   Maintains an issue log detailing specific issues, actions/interventions to address issue and resolution of issue.  As indicated, monitors to ensure issue remains resolved.
 
Assists in the development of Primaris Quality Data Services Process Improvement menu of services for client organizations, e.g., maximization of medical record review efforts through additional data capture, development of score cards showing trends, and strategies for Core Measure compliance.
 
Works with Chief Financial Officer and Director, Business Development, to prepare RFP responses and serve as technical resource related to sales and operations.
 
Develops and maintains policies and procedures related to the abstraction of data from medical records by the Quality Data Services Core Measure Abstractors.  Communicates new or revised policies and procedures to all relevant staff in a timely manner.
 
Develops and provides orientation for new Core Measure Abstractors related to their assigned area of abstraction or responsibility.
 
Provides monthly data for each client regarding abstraction services to the financial department for billing purposes.
 
Abides by the established security and confidentiality policies and procedures.
 
Reports routinely to designated supervisor.
 
Completes timesheets timely.
 
Supervisory Responsibilities                                             
 
Supervises and manages Core Measure abstractors and Project Leads.  Interviews, hires, and evaluates all Core Measure abstractors.  Provides education, coaching, and recommends/develops performance management plans and goals for Core Measures Abstraction staff within the Quality Data Services department.
 
Competencies                                              
 
To perform the job successfully, an individual should demonstrate the following competencies:
 
Analytical - Uses intuition and experience to complement data; Designs/redesigns work flow and procedures to enhance effectiveness and efficiency of services.
 
Problem Solving - Identifies and resolves problems in a timely manner; gathers and analyzes information skillfully; develops alternative solutions; works well in group problem solving situations; uses reason even when dealing with emotional topics.
 
Project Management - Develops project plans and effectively coordinates projects; communicates changes and progress in an effectively and timely manner; completes projects on time and budget; effectively manages project team activities.
 
Technical Skills - Assesses own strengths and weaknesses; pursues training and development opportunities; strives to continuously build knowledge and skills; shares expertise with others.
 
Customer Service -Responds promptly to customer needs; solicits customer feedback to improve service; responds to requests for service and assistance; meets commitments; has ability to understand and resolve difficult or emotional customer situations.
 
Interpersonal Skills - Focuses on solving conflict, not blaming; maintains confidentiality; listens to others without interrupting; keeps emotions under control; remains open to others' ideas and tries new things.
 
Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; responds well to questions; demonstrates group presentation skills; participates in meetings.
 
Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.
 
Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.
 
Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values.
 
Organizational Support - Follows policies and procedures; Completes administrative tasks correctly and on time; Supports organization's goals and values; Benefits organization through outside activities; Supports affirmative action and respects diversity.
 
Planning/Organizing - Prioritizes and plans work activities; Uses time efficiently; Plans for additional resources; Sets goals and objectives; Develops realistic action plans.
 
Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
 
Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.
 
Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly.
 
Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.
 
Attendance/Punctuality - Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.
 
Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan.
           
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
 
Education and/or Experience                                 
 
Registered Nurse or other comparable clinical healthcare knowledge or experience required.
 
Advanced degree in nursing, healthcare management or other healthcare related field preferred.
 
Current quality certification and training (CPHQ) preferred.
 
A minimum of 3 years’ management experience required.
  
Minimum of  five years in an acute care facility and demonstrates a clear working knowledge of Core Measures and other data reporting requirements, general hospital operations, Joint Commission, Medicare Conditions of Participation, and state requirements.
 
Minimum of two years’ experience in Performance Improvement /Quality Management required.
 
Knowledge of healthcare practices, medical terminology, and treatment modalities required.
 
Experience with continuous quality improvement processes, and utilization management desired.
 
Certificates, Licenses, Registrations
 
Registered Nurse or other comparable clinical healthcare license/degree required.  Advanced degree in nursing, healthcare management or other healthcare related field preferred.
 
Current quality certification and training (CPHQ) preferred.
 
Language Skills                                           
 
Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents. Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community.  Ability to effectively present information to top management, public groups, and/or boards of directors. 
 
Mathematical Skills                                                 
 
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry. 
 
Reasoning Ability                                                    
 
Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
 
Computer Skills                                           
 
Experience with Microsoft Word, Adobe applications and Core Measure vendor tools.
 
Other Skills and Abilities                                                    
 
Computer knowledge and skills requisite for review of online and scanned medical records and data entry into online abstraction tools.
 
Excellent written and oral communication skills.
 
Familiarity and comprehension of drug dosing metrics.
 
Ability to function independently and as an effective team member.
 
Excellent organizational and time management skills.
 
Other Qualifications                                                
None.
 
Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
 
While performing the duties of this Job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is frequently required to walk. The employee is occasionally required to stand; climb or balance and stoop, kneel, crouch, or crawl. The employee must regularly lift and /or move up to 10 pounds, frequently lift and/or move up to 25 pounds and occasionally lift and/or move up to 50 pounds.  Specific vision abilities required by this job include close vision, distance vision, depth perception and ability to adjust focus.
 
Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
 
Employee may work remotely but must maintain a HIPAA compliant home office and travel to corporate office and for onsite visits periodically as needed.

Company Info


Primaris Holdings, Inc.
200 N Keene Street Columbia, MO, United States
Phone: 573-817-8300, ext 182
Web Site: http://primaris.org/join-our-team/

Program Manager - Core Measure Abstraction, Quality Data Services

Job Summary
col-narrow
License: RN - Registered Nurse
Specialty: General
Location: Remote, MO
Employment Type: Full time
Job Description
col-wide
Summary
 
This position has primary responsibility for the day-to-day operations for Core Measures Abstraction services within the Primaris Quality Data Services Department.
 
Essential Duties and Responsibilities include the following. Other duties may be assigned.
 
Oversees contract Core Measure Abstraction services on a day-to-day basis to meet contract requirements within budgetary constraints.  Work in conjunction with Project Leads to monitor compliance with all contract requirements related to abstraction.
 
Perform Core Measure abstraction as described in the Core Measure Abstractor job description as required to ensure meeting contract requirements. Assist Project Leads in determining work assignments for per diem staff to ensure contract requirements are met and productivity of salaried staff is maintained.
 
Participates in regular conference calls, as required by each client.  Helps guide discussion to address abstraction concerns or issues, documentation issues, record completion, and other issues directly related to abstraction of data.  In conjunction with Project Lead, arranges/coordinates additional conference calls or Webex to resolve specific issues related to abstraction, documentation, reporting or other concerns, as indicated.
 
Provides reports and information to the organization as specified in the contract or as requested by the client in an effective and timely manner.  Uses feedback from the organization to improve reports.
 
Monitors compliance with contract requirements for record completion according to established deadlines, using daily tracking log or other tools as appropriate for the services being provided.  Reviews tracking logs maintained by Project Leads.  Works with the Project Lead in developing and implementing action plans as required to ensure record completion deadlines are met.
 
Maintains regular contact with all Project Leads and abstractors.  Assigns measures to abstractors in conjunction with Project Lead, according to their training/skill level.    Serves as resource to Project Leads and abstractors to resolve issues related to abstraction, criteria interpretation, documentation, and work performance.  Submits recommendations or questions from Primaris abstractors to the client for consideration and/or resolution or works with Project Leads to submit recommendations.  Provides follow-up to abstractors related to conference calls and other issue resolution.
 
Serves as a resource to the organization regarding current Core Measure criteria, as well as changes in Core Measures anticipated in the future.  Provides recommendations and resources that might be beneficial to organization in improving Core Measure performance based on information obtained from abstraction and other resources.
 
Develops and maintains a strong working relationship with the primary contacts at each organization.  Works collaboratively with the organization to resolve issues.
 
Identifies need for additional education or training for Primaris abstractors and/or organization/contract staff.  Works with Director of Quality Data Services to develop and implement training programs to ensure Primaris Quality Data Services Core Measure Abstraction staff maintain current and complete knowledge of the abstraction rules and guidelines.
 
Conducts/reviews inter-rater reliability (IRR) reviews on all Core Measure Abstractors on a quarterly basis, including Project Leads. Provides documented feedback to each abstractor and recommends/provides additional education/training for abstractors when a pattern or trend is identified through IRR reviews. Monitors Project Lead response and application of feedback into current abstraction processes.  Works in conjunction with Project Leads to monitor abstractor response and application of feedback. 
 
Receives and applies feedback from IRR conducted on own work by Project Lead or other abstractors.
 
Maintains current knowledge of all applicable federal and state laws and regulations as well as individual contract requirements.
 
Develops and coordinates project management tasks including planning, implementation budget, and staffing for maintenance of contract requirements with clients. Provides ongoing feedback to client during new contract implementation through use of a written project plan.
 
Provides detailed variance reports, with recommendations for possible action plans to clients based on abstraction findings, trends, or patterns.  Identifies and reports patterns/trends by measure, provider, and department/unit, when possible.
 
Develops and maintains a strong working relationship with the primary contacts at each organization.  Works collaboratively with the organization to resolve issues in a timely and effective manner.   Maintains an issue log detailing specific issues, actions/interventions to address issue and resolution of issue.  As indicated, monitors to ensure issue remains resolved.
 
Assists in the development of Primaris Quality Data Services Process Improvement menu of services for client organizations, e.g., maximization of medical record review efforts through additional data capture, development of score cards showing trends, and strategies for Core Measure compliance.
 
Works with Chief Financial Officer and Director, Business Development, to prepare RFP responses and serve as technical resource related to sales and operations.
 
Develops and maintains policies and procedures related to the abstraction of data from medical records by the Quality Data Services Core Measure Abstractors.  Communicates new or revised policies and procedures to all relevant staff in a timely manner.
 
Develops and provides orientation for new Core Measure Abstractors related to their assigned area of abstraction or responsibility.
 
Provides monthly data for each client regarding abstraction services to the financial department for billing purposes.
 
Abides by the established security and confidentiality policies and procedures.
 
Reports routinely to designated supervisor.
 
Completes timesheets timely.
 
Supervisory Responsibilities                                             
 
Supervises and manages Core Measure abstractors and Project Leads.  Interviews, hires, and evaluates all Core Measure abstractors.  Provides education, coaching, and recommends/develops performance management plans and goals for Core Measures Abstraction staff within the Quality Data Services department.
 
Competencies                                              
 
To perform the job successfully, an individual should demonstrate the following competencies:
 
Analytical - Uses intuition and experience to complement data; Designs/redesigns work flow and procedures to enhance effectiveness and efficiency of services.
 
Problem Solving - Identifies and resolves problems in a timely manner; gathers and analyzes information skillfully; develops alternative solutions; works well in group problem solving situations; uses reason even when dealing with emotional topics.
 
Project Management - Develops project plans and effectively coordinates projects; communicates changes and progress in an effectively and timely manner; completes projects on time and budget; effectively manages project team activities.
 
Technical Skills - Assesses own strengths and weaknesses; pursues training and development opportunities; strives to continuously build knowledge and skills; shares expertise with others.
 
Customer Service -Responds promptly to customer needs; solicits customer feedback to improve service; responds to requests for service and assistance; meets commitments; has ability to understand and resolve difficult or emotional customer situations.
 
Interpersonal Skills - Focuses on solving conflict, not blaming; maintains confidentiality; listens to others without interrupting; keeps emotions under control; remains open to others' ideas and tries new things.
 
Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; responds well to questions; demonstrates group presentation skills; participates in meetings.
 
Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.
 
Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.
 
Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values.
 
Organizational Support - Follows policies and procedures; Completes administrative tasks correctly and on time; Supports organization's goals and values; Benefits organization through outside activities; Supports affirmative action and respects diversity.
 
Planning/Organizing - Prioritizes and plans work activities; Uses time efficiently; Plans for additional resources; Sets goals and objectives; Develops realistic action plans.
 
Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
 
Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.
 
Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly.
 
Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.
 
Attendance/Punctuality - Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.
 
Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan.
           
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
 
Education and/or Experience                                 
 
Registered Nurse or other comparable clinical healthcare knowledge or experience required.
 
Advanced degree in nursing, healthcare management or other healthcare related field preferred.
 
Current quality certification and training (CPHQ) preferred.
 
A minimum of 3 years’ management experience required.
  
Minimum of  five years in an acute care facility and demonstrates a clear working knowledge of Core Measures and other data reporting requirements, general hospital operations, Joint Commission, Medicare Conditions of Participation, and state requirements.
 
Minimum of two years’ experience in Performance Improvement /Quality Management required.
 
Knowledge of healthcare practices, medical terminology, and treatment modalities required.
 
Experience with continuous quality improvement processes, and utilization management desired.
 
Certificates, Licenses, Registrations
 
Registered Nurse or other comparable clinical healthcare license/degree required.  Advanced degree in nursing, healthcare management or other healthcare related field preferred.
 
Current quality certification and training (CPHQ) preferred.
 
Language Skills                                           
 
Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents. Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community.  Ability to effectively present information to top management, public groups, and/or boards of directors. 
 
Mathematical Skills                                                 
 
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry. 
 
Reasoning Ability                                                    
 
Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
 
Computer Skills                                           
 
Experience with Microsoft Word, Adobe applications and Core Measure vendor tools.
 
Other Skills and Abilities                                                    
 
Computer knowledge and skills requisite for review of online and scanned medical records and data entry into online abstraction tools.
 
Excellent written and oral communication skills.
 
Familiarity and comprehension of drug dosing metrics.
 
Ability to function independently and as an effective team member.
 
Excellent organizational and time management skills.
 
Other Qualifications                                                
None.
 
Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
 
While performing the duties of this Job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is frequently required to walk. The employee is occasionally required to stand; climb or balance and stoop, kneel, crouch, or crawl. The employee must regularly lift and /or move up to 10 pounds, frequently lift and/or move up to 25 pounds and occasionally lift and/or move up to 50 pounds.  Specific vision abilities required by this job include close vision, distance vision, depth perception and ability to adjust focus.
 
Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
 
Employee may work remotely but must maintain a HIPAA compliant home office and travel to corporate office and for onsite visits periodically as needed.


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