Director, Clinical Data Acquisitions & Member/Provider Services

The Director, Clinical Data Acquisition & Member/Provider Services is critical for ensuring that an organization obtains the necessary patient health information for quality improvement initiatives, risk adjustment, and regulatory compliance.  Responsible for the implementation, monitoring, and oversight of all chart collection for HEDIS, or HEDIS-like projects, Risk Adjustment, Risk Adjustment Data Validation, and other state specific audit projects and deliverables. Also works with the Health Plan and other contracted entities to strategically plan for supplemental data sourced (SDS) to be sent from and ingested into the quality/risk reporting system. Oversees management and training for team members as well as training on the quality/risk reporting systems.

Will be the primary point of contact for member/provider related issues and concerns. Leads and directs the team to ensure high standards of service. Working in collaboration with other departments and stakeholder to align services with member/provider needs, along with overseeing the risk management reporting system and training.

PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.

• Superlative people and customer service skills
• Exhibits professional management skills including time management, organizational, and prioritization skills
• Demonstrates ability and skill through prior experience and/or academic expertise in actively leading and managing large-scale change
• Current knowledge of health plan audit programs and survey programs such as CMS Stars, PAS, PAAS, IHA AMP, Risk Adjustment, MIPS, and other related audit activities.
• General knowledge of Information Systems technology. Ability to discuss system problems and requirements with managers and employees in user functions, and be able to present findings in verbal and written form
• Develops reports for executive, practitioners, and staff on the quality performance

Required:

• Bachelor’s Degree
• Five (5) or more years of project experience/data management
• Knowledge of American Recovery and Reinvestment Act (ARRA) Merit-based Incentive Payment System (MIPS)
• Knowledge of quality and risk reporting programs (IHA AMP, CMS Stars, QPP and HCCs)

Preferred:

• Clinical experience working with quality management systems similar to those at PIH Health