Director, Clinical Quality, Training, Oversight and Innovation

Inovalon was founded in 1998 on the belief that technology, and data specifically, would empower the transformation of the entire healthcare ecosystem for the better, improving both outcomes and economics. At Inovalon, we believe that when our customers are successful in their missions, healthcare improves. Therefore, we focus on empowering them with data-driven solutions. And the momentum is building.

Together, as ONE Inovalon, we are a united force delivering solutions that address healthcare’s greatest needs. Through our mission-based culture of inclusion and innovation, our organization brings value not just to our customers, but to the millions of patients and members they serve.

Overview: The Director, Clinical Quality, Training, Oversight and Innovation is engaged in defining and executing the overall clinical quality strategy and direction of the organization pertaining to data abstraction from medical records in any format for all Inovalon products. In addition, this position leads the design and execution of all clinical training and quality oversight for data abstraction for the organization and its vendors internationally. The position provides clinical direction to the Product, Operations, Client Services, and Innovation teams and drives clinical collaboration across these teams on a national level.

Duties and Responsibilities:

Develop and maintain an expert level of knowledge regarding products, services, capabilities, infrastructure, and operations of Employer and its affiliates, the marketplace, competition, strategic positioning, threats and direction to achieve optimal insight and success with respect to Employer’s (and those of its affiliates) products, services, capabilities, support, functionality requirements, and financial performance.

Lead, drive, and ultimately be responsible for planning, implementation, execution, and successful achievement of the overall clinical quality strategy and direction of the organization pertaining to data abstraction from medical records, and the design and execution of all clinical training and quality oversight for data abstraction for the organization and its vendors internationally, including:

Serve as subject matter expert for risk-adjustment and HEDIS for the company, engaging frequently in client services functions as well as business development and marketing. Serve as an internal resource to drive and maintain Inovalon’s thought leadership in the RA and HEDIS industry. Participate in industry conferences as an expert presenter.

Responsible for training all internal staff, partners, and vendors internationally on accurate medical data abstraction (for all products, including RA and HEDIS) in compliance with all coding and regulatory requirements. This includes initial development and annual updates of all training materials annually or more frequently as appropriate.

Responsible (in collaboration with MRR Operations leadership) for quality oversight of all internal staff, partners, and vendors internationally in the performance of medical data abstraction (for all products, including RA and HEDIS), in compliance with all regulatory requirements. This includes identifying opportunity and driving execution of quality pullback processes and driving tool upgrades as warranted.

Responsible for execution of all Joint Quality Audit processes across RA and HEDIS clients, including promoting appropriate contractual language as permitted by Product leads. This requires significant client interaction with promotion of Inovalon’s best-in-class review process as well as representation of Inovalon’s position/performance in the context of third-party audits and other client-specific projects.

Serve as clinical expert in development/improvement of all tools/systems related to medical data abstraction.

Serve as clinical liaison to the Innovation team, collaborating to drive development and promotion of new market capabilities in the context of data abstraction (such as NLP). In addition, this position assists the Innovation team in performing its due diligence around onboarding new EMR partners to ensure CDE meets all clinical and regulatory requirements for use by Inovalon and its clients.

Responsible (in collaboration with relevant teams, such as Innovation) for design and execution of clinical quality oversight processes for ensuring clinical and regulatory validity of records received through EMR interoperability capabilities.

Maintain compliance with lnovalon's policies, procedures and mission statement.

Adhere to all confidentiality and HIPAA requirements as outlined within lnovalon's Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position.

Fulfill those responsibilities and/or duties that may be reasonably provided by lnovalon for the purpose of achieving operational and financial success of the Company.

Uphold responsibilities relative to the separation of duties for applicable processes and procedures within your job function.

We reserve the right to change this job description from time to time as business needs dictate and will provide notice of such.

Education:

Bachelor’s Degree in Arts/Sciences (B.A./B.S.) preferred and

Active RN license required

Experience:

Active RN license required with a minimum of 12+ years of relevant overall experience, and 6 years high level management experience, preferably in a Director level or higher role required

Minimum of 5 years’ experience in quality and/or compliance required

Minimum of 5 years’ experience in medical coding required

Minimum of 5 years’ experience with adult learning/training required

Skills and Abilities:

Outstanding attention to detail with the ability to set priorities and work on multiple tasks simultaneously;

Strong computer skills required, specifically with Microsoft Office and data collections tools;

Ability to manage and meet deadlines;

Strong interpersonal skills; and

Professionally skilled in verbal and written communication.

Working Conditions and Physical Demands:

This is a primarily sedentary role. The employee is regularly required to sit, talk, and hear for extended periods of time, and also required to repetitively use manual labor to operate a computer keyboard and other office equipment.

The employee may occasionally need to stand, walk, or lift and/or move up to 10 pounds. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  Inovalon Offers a Competitive Salary and Benefits Package

In addition to the base compensation, this position may be eligible for performance-based incentives.

The actual base pay offered may vary depending on multiple factors including, but not limited to, job-related knowledge/skills, experience, business needs, geographical location, and internal equity.  At Inovalon, it is not typical for an individual to be hired at or near the top end of the range for their role, and compensation decisions are dependent upon the facts and circumstances of each position and candidate.

Inovalon invests in associates to help them stay healthy, save for long-term financial goals, and manage the demands of work and personal commitments. That’s why Inovalon offers a valuable  benefits package  with a wide range of choices to meet associate needs, which may include health insurance, life insurance, company-paid disability, 401k, 18+ days of paid time off, and more.

Base Compensation Range $132,000 — $176,000 USD

This position is not eligible for immigration sponsorship (e.g. H-1B, TN, or E-3). Applicants must be authorized to work in the United States as a condition of employment. (This is only applicable for US-based positions)

If you don’t meet every qualification listed but are excited about our mission and the work described, we encourage you to apply .  Inovalon is most interested in finding the best candidate for the job , and you may be just the right person for this or other roles.  

By embracing inclusion , we enhance our work environment and drive business success. Inovalon strives to provide equal opportunit ies to the communities where we operate and to our clients and everyone whom we serve. We endeavor to create a culture of inclusion in which our associates feel empowered to bring their full, authentic selves to work and pursue their professional goals in an equitable setting. We understand that by fostering this type of culture, and welcoming different perspectives, we generate innovation and growth.  

Inovalon is proud to be an equal opportunity workplace . We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or v eteran status. We also consider qualified applicants regardless of criminal histories, consistent with legal requirement.  

To review the legal requirements, including all labor law posters, please visit this link

To review the California Consumer Privacy Statement: Disclosures for California Residents, please visit this  link