Inovalon

  • Clinical Quality Manager

    Job Locations US-MD-Bowie
    Requisition ID
    2018-8991
  • Overview

    Inovalon, a leading technology company that combines advanced cloud-based data analytics and data-driven intervention platforms to achieve meaningful insight and impact in clinical and quality outcomes, utilization, and financial performance across the healthcare landscape. This commitment to quality is manifest in the ongoing infusion and maintenance of quality assurance and monitoring processes throughout its operational, human resource, technology, and service delivery processes. In fact, the Inovalon philosophy and approach to quality assurance is to integrate the awareness, comprehensive measurement and assessment, and improvement of quality into all processes of the organization.

    Responsibilities

    • Hold responsibility for the quality and efficiency of the assigned quality review team;
    • Assist with the design, execution, and management of ongoing quality assessment procedures for all review personnel;
    • Ensure quality review team is maintaining high standards of quality and reliability;
    • Enforce quality requirements and standards;
    • Assist with the development, organization and implementation of companywide quality improvement efforts;
    • Maintain the control and ongoing monitoring of quality and reliability as well as quality reporting mechanisms and management tools;
    • Ensure compliance with contractual, local, state and national quality standards;
    • Through direction from the Director of Quality, provide direct feedback, quality /process counseling and coaching, retraining and when necessary reassignment or termination decisions for review personnel regarding quality issues;
    • Manage the development and delivery of reviewer training for assigned projects;
    • Assist with the oversight and management of Inovalon training processes (both initial and ongoing training) for all review personnel;
    • Maintain oversight of the quality and effectiveness of all review associates during  training and through project execution;
    • Maintain open lines of communication with Director of Quality, Senior Operations Manager and Client Service Managers regarding on-going overread and quality activity as it relates to client and operations management;
    • Make recommendations for process and technical changes, and document changes to custom review training materials;and
    • Assist the Director of Quality in performing IRR and Over-read accuracy testing for all review and quality personnel according to contract requirements and provide results data to Client Service Managers for communication to clients.

    Qualifications

    • Certified Coder with at least 1 year of coding experience   or

           Licensed Nurse with at least 2 years of clinical experience and has either:

      • Certified Coding Credential or
      • Has successfully completed the Inovalon ICD-10 Coding Course/Program
      • HEDIS experience preferred;
    • Strong working knowledge of medical terminology;
    • Strong working knowledge of coding guidelines and regulations as they relate to Risk Adjustment;
    • Must be able to achieve and maintain the accuracy standard of 95% or better;
    • Must be able to consistently meet productivity standards as per department policy;
    • Computer literate; familiar with Microsoft Office applications;
    • Professionally skilled in verbal and written communication;
    • Detail oriented and ability to effectively multi-task;
    • Excellent communication skills;and
    • Ability to work well in groups as well as work well independently.

    Inovalon provides equal employment opportunities (EEO) to all employees and applicants for employment. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or protected veteran status and will not be discriminated against on the basis of disability.

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