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The Market Executive of Clinical Quality will be responsible for driving clinical quality and regulatory metrics by onsite leadership in assigned market. The Market Executive will be accountable for the following: clinical and survey metrics, clinical operations metrics, claims denials, AO/state survey results, risk mitigation, clinical compliance, QAPI adherence and VBP performance. Works closely with area operations and branch leaders on processes, initiatives and relevant in-scope changes or updates.
Reports To: Regional VP, Home Health Clinical Quality
FLSA: Exempt
Work Schedule : Full-time/40 Hours
Position Type : Hybrid (Remote & Field-based Travel)
Assigned Markets: CA and NV
The RN Market Executive of Clinical Quality will be responsible for driving clinical quality and regulatory metrics by onsite leadership in assigned market. The Market Executive will be accountable for the following: clinical and survey metrics, clinical operations metrics, claims denials, AO/state survey results, risk mitigation, clinical compliance, QAPI adherence and VBP performance. Works closely with area operations and branch leaders on processes, initiatives and relevant in-scope changes or updates.
Essential Functions: Those functions that the individual who holds the position must be able to perform unaided or with the assistance of reasonable accommodation.
Drives improvement in clinical quality & regulatory metrics in assigned branches through coaching frontline clinical managers and staff on improving care delivery and documentation requirements.
Implements and monitors clinical performance of advanced clinical care programs into assigned branches.
Regularly monitors quality metrics for assigned Market; Reports key insights to AVP of Ops & Area Exec of Clinical Quality and other key Clinical/Ops stakeholders.
Conducts survey audits to prepare for official surveys and supports locations through survey process.
Conducts meaningful virtual/in-person branch interactions to drive performance.
Use your skills to make an impact
Knowledge/Skills/Abilities/Expectations:
Knowledge of business management and government regulations; expertise in relevant state regulations and survey activities.
Ability to read, analyze and interpret medical documents, financial reports and legal documents.
Ability to coach/mentor branch leadership and clinicians to influence changes in day-to-day clinical activities.
Proactively engages to identify and address issues.
Expertise in branch-level clinical workflows an organization structure.
Rich analysis of clinical data to derive key insights & opportunities.
Strong judgement on workflow and process improvement.
Effective influencing and communication.
Strong execution capabilities.
Travel approximately 50% -75%. The role requires the ability to travel within the assigned market on short notice. The California market includes branch locations in San Diego, Alameda, San Jose, and Oakland. The Nevada market includes branch locations in Las Vegas, Reno, Carson City, and Fernley.
Must reside within the state of California or Nevada.
Education:
Associate degree in Nursing (ADN) required; Bachelor of Science in Nursing (BSN) strongly preferred.
License/Certifications:
Active RN license in good standing.
Active RN license for the states of California and/or Nevada, required.
Experience:
Previous experience in home-based care required, including Home Health, Hospice, and/or Palliative Care settings.
Previous experience in home-based care functioning in a branch leadership (Branch Director/Administrator) or Clinical Manager role strongly preferred.
Multi-site management and operations experience strongly preferred.
Management and people leadership experience, required.
Experience with clinical quality improvement and survey preparation, required.
OASIS experience strongly preferred. OASIS certification (HCS-O, COQS, and/or COS-C), preferred.
Homecare Homebase (HCHB) experience strongly preferred.
Experience with CMS/Medicare regulations and accreditation standards, required.
Knowledge of CMS PDGM billing requirements, preferred.
Experience managing healthcare revenue.
Additional Information:
Work Environment: Hybrid (Remote & Field-based Travel)
Travel Expectations: up to 50% -75% of time. Associated travel will be in the states of California and Nevada.
Normal Hours of Operation: M-F / 8a-5p (ET)
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$104,000 - $143,000 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
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Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options https://www.partnersinprimarycare.com/accessibility-resources
