ACO Quality Lead: RN Driving Medicare Performance

Provider Partners; United States; Vor Ort; USD 95.000 - 140.000; Vollzeit

Zusammenfassung

Provider Partners seeks an ACO Quality Manager (RN) to lead quality performance efforts across MSSP, ACO REACH, and LEAD programs. You will analyze diverse data sources, conduct medical-record audits, and develop targeted training to close care gaps and improve documentation.

Responsibilities include auditing, educating clinicians, and delivering live and virtual trainings while ensuring HIPAA compliance and regulatory alignment across CMS models. Six Sigma mindset preferred.

Qualifikationen

• Active and unrestricted Registered Nurse license.
• Bachelor of Science in Nursing or equivalent combination of nursing education and relevant experience.
• Experience working with Medicare accountable care or value-based care programs, including MSSP, ACO REACH, LEAD, or comparable risk‑based models.
• Working knowledge of CMS quality measures, measure specifications, clinical documentation requirements, and quality‑reporting methodologies.
• Experience conducting medical-record audits, chart abstraction, or clinical documentation reviews.
• Demonstrated ability to analyze healthcare data and translate findings into actionable clinical recommendations.
• Experience developing and delivering education for physicians, advanced practice providers, nurses, practice managers, or other healthcare professionals.
• Experience creating and executing training through live, virtual, and e‑learning platforms.
• Excellent presentation and facilitation skills, with the ability to communicate complex clinical, analytical, and regulatory information clearly and confidently.
• Strong understanding of preventive care, chronic disease management, care transitions, and population health principles.
• Proficiency with electronic health records, population health platforms, Microsoft Excel, presentation software, and quality‑performance reporting tools.
• Excellent written and verbal communication skills.
• Strong attention to detail, critical‑thinking ability, and professional judgment.
• Ability to manage multiple priorities and meet regulatory and operational deadlines.

Aufgaben

• Monitor organizational performance against applicable MSSP, ACO REACH, LEAD, and other CMS quality measures and reporting requirements.
• Interpret quality-measure specifications, technical guidance, reporting requirements, and CMS program updates.
• Analyze clinical, claims, pharmacy, laboratory, and supplemental data to identify quality gaps, documentation deficiencies, utilization trends, and improvement opportunities.
• Conduct medical-record audits to validate measure compliance, clinical documentation, coding accuracy, and supporting evidence.
• Perform targeted chart reviews for preventive care, chronic disease management, transitions of care, medication reconciliation, and other applicable quality measures.
• Reconcile quality data across electronic health records, population health platforms, claims files, registries, and provider-submitted documentation.
• Investigate discrepancies between reported performance and supporting medical-record documentation.
• Develop and maintain audit tools, measure-specific workflows, validation procedures, and quality-performance tracking reports.
• Provide clear, actionable feedback to physicians, advanced practice providers, nurses, practice managers, and other clinical personnel.
• Develop and execute comprehensive training programs across live, virtual, and e-learning platforms.
• Design engaging educational content, presentations, webinars, recorded modules, job aids, assessments, and other learning resources.
• Deliver professional presentations and training sessions to providers, clinical teams, operational leaders, and other stakeholders.
• Evaluate training effectiveness, knowledge retention, learner engagement, and the impact of education on quality performance.
• Train providers and staff on quality-measure requirements, documentation standards, evidence-based care expectations, and methods for closing care gaps.
• Adapt training content and delivery methods to meet the needs of different audiences, clinical settings, and levels of experience.
• Support prospective and retrospective quality‑improvement initiatives across participating practices and facilities.
• Collaborate with analytics, clinical operations, compliance, coding, care management, provider-engagement, and learning and development teams.
• Assist with quality-data submission, validation, reconciliation, and audit‑readiness activities.
• Track corrective actions and follow‑up activities resulting from chart audits, data reviews, or identified performance deficiencies.
• Identify barriers to quality performance and recommend practical workflow, documentation, technology, or educational improvements.
• Support provider performance meetings by preparing reports, summarizing findings, and presenting improvement recommendations.
• Maintain current knowledge of CMS accountable care models, quality methodologies, measure changes, reporting deadlines, and regulatory requirements.
• Protect beneficiary information and perform all responsibilities in accordance with HIPAA, organizational privacy policies, and applicable regulatory requirements.

Kenntnisse

Quality‑measure expertise

Medical-record auditing

Data analysis

Training delivery

Provider education

Public speaking

Cross‑functional collaboration

Regulatory interpretation

Ausbildung

Bachelor of Science in Nursing

Experience with Medicare MSSP/ACO programs

Tools

Power BI

Tableau

SQL

Excel

Jobbeschreibung

Provider Partners seeks an ACO Quality Manager (RN) to lead quality performance efforts across MSSP, ACO REACH, and LEAD programs. You will analyze diverse data sources, conduct medical-record audits, and develop targeted training to close care gaps and improve documentation.

Responsibilities include auditing, educating clinicians, and delivering live and virtual trainings while ensuring HIPAA compliance and regulatory alignment across CMS models. Six Sigma mindset preferred.