Find & Apply For Clinical Quality Manager Jobs in Spring Hill, Florida

Overview We are seeking a highly skilled and detail-oriented HEDIS & Quality Performance Manager to lead our healthcare quality improvement initiatives. The ideal candidate will possess experience and comprehensive knowledge of healthcare compliance, regulatory standards, and data analysis to enhance clinical performance, and ensure adherence to industry regulations. This role offers an exciting opportunity to influence patient outcomes, optimize quality metrics, and support organizational excellence within a managed care environment. The successful candidate will demonstrate strong leadership capabilities, technical proficiency, and a passion for advancing healthcare quality standards. Pay is also based on experience Duties Develop, implement, and monitor strategies to improve Healthcare Effectiveness Data and Information Set (HEDIS) scores and other quality performance metrics. Lead cross-functional teams in executing quality improvement projects aligned with accreditation standards such as JCAHO and CMS regulations. Analyze clinical data using advanced data analysis tools to identify gaps in care, trends, and opportunities for process enhancement. Ensure compliance with

HIPAA, FDA

regulations, ICD coding (ICD-9/10), CPT coding, and other healthcare laws governing patient information and medical documentation. Conducts face-to-face visits with physicians and practices, educates staff/providers on utilization and performance reports, and reviews KPI reports. Collaborate with clinical staff to develop training programs on medical terminology, coding practices, and healthcare compliance policies. Drive process improvements by applying project management methodologies to streamline workflows and optimize quality assurance procedures. Maintain up-to-date knowledge of CMS regulatory compliance requirements related to Medicare and managed care programs; implement necessary adjustments accordingly. Lead efforts in risk management by evaluating potential compliance issues and implementing mitigation strategies within healthcare operations. Foster a culture of continuous quality improvement through team leadership, staff education, and performance measurement initiatives. Qualifications Bachelor's degree in Healthcare Administration, Nursing, Public Health, Marketing or a related field Experience in healthcare quality management, with proven success in improving HEDIS scores or similar performance metrics. Strong understanding of healthcare regulation policies including CMS guidelines, JCAHO accreditation standards, HIPAA privacy rules, and FDA regulations. Proficiency with EMR/EHR systems and Microsoft Office Suite for data analysis and reporting purposes. Demonstrated project management skills with experience leading complex healthcare initiatives from inception to completion. In-depth knowledge of ICD coding (ICD-9/10), CPT coding, medical terminology, and Medicare regulations. Excellent analytical skills with the ability to interpret large datasets for actionable insights. Effective team leadership capabilities with experience managing multidisciplinary teams in a healthcare setting. Familiarity with process improvement methodologies such as Lean or Six Sigma is advantageous. Join our organization, Incentive Care LLC, as we strive for excellence in healthcare quality performance through innovative strategies and dedicated leadership!

Pay:

From $65,000.00 per year

Benefits:

Health insurance Paid time off

Education:

High school or equivalent (Preferred)

Experience:

coding compliance: 1 year (Preferred)

Quality HEDIS :

2 years (Required) Ability to

Commute:

Trinity, FL 34655 (Required) Willingness to travel: 50% (Required)

Work Location:

In person