Manager, Clinical Quality and Informatics

Description

Position Overview

The Manager helps affiliated primary care practices improve quality performance, patient outcomes, documentation accuracy, workflow efficiency and financial performance under MSSP, Medicare Advantage and commercial value-based care arrangements. The role connects practice teams with quality, analytics, coding, information technology and value-based care resources across more than 50 practices and multiple EHR platforms.

This is a provider-facing role, not solely an analytics position. The Manager translates data and payer requirements into practical workflows, training and sustained performance improvement for physicians, advanced practice providers and clinic staff.

Requirements

Essential Responsibilities

Clinical Informaticist & Data Integrity

• Learn assigned EHR systems capabilities to run quality reporting for submitting to Payers Validate clinical data across EHR, payer and internal reporting platforms; identify and help resolve missing, inaccurate or improperly mapped information.
• Assess each practice’s staffing, workflows and performance barriers; develop practical improvement plans and track progress.
• Redesign workflows to improve EMR reporting capabilities
• Partner with analytics, IT, EHR vendors, coding and compliance teams to troubleshoot reporting and documentation issues.
• Test new reports, templates and workflows; document data definitions, system limitations and corrective actions.

Practice Transformation & Relationships

• Support an assigned portfolio of affiliated primary care practices and build trusted relationships with providers, medical assistants, practice leaders and front-office staff.
• Provide onsite and virtual coaching, job aids and follow-up support; influence change without direct authority.

Quality, Population Health & Risk Adjustment

• Analyze HEDIS, Medicare Advantage Star, MSSP, preventive care, chronic disease, utilization and other payer performance measures and identify opportunities for improvement.
• Educate practice teams on compliant chronic-condition documentation, HCC principles and documentation completeness.
• Provide practical feedback while reinforcing that all diagnoses and coding must be clinically supported and compliant.

Program Support

• Maintain working knowledge of CMS, payer and value-based care requirements relevant to assigned practices.
• Support affiliate onboarding, practice transformation projects and standardization of effective workflows across the network.
• Provide concise updates on progress, barriers, risks and recommended actions; complete assigned work accurately and on schedule.

Qualifications

Required

• Three to five years of experience in healthcare analytics, population health, quality improvement, clinical informatics, practice transformation or value-based care.
• At least two years of experience working in or directly supporting primary care practices.
• Experience with HEDIS, Star measures, preventive care, chronic-condition documentation, HCCs and chart review.
• Experience using EHR systems for reporting, workflow improvement, training or end-user support; comfort learning multiple platforms.
• Ability to interpret performance data and convert findings into practical actions for small practice teams.
• Strong provider-relations, training, communication, organization and independent project-management skills.
• Proficiency with Microsoft Excel and standard Microsoft Office applications.
• Ability to travel to practices; valid driver’s license and reliable transportation when required.

Preferred

• Bachelor’s degree in health informatics, healthcare administration, nursing, public health, health information management, analytics or a related field; comparable experience considered.
• Experience supporting multiple independent practices, an ACO, IPA, CIN, MSO or multi-site primary care organization.
• Knowledge of ICD-10-CM, CPT, documentation integrity and coding-compliance principles.
• CPC, CRC, CCS, CPHQ, Lean, Six Sigma or related certification; experience with Power BI, Tableau or SQL.

Core Competencies Measures of Success

•  Provider relationship building
•  Workflow assessment and redesign
•  Data interpretation and problem solving
•  Training and change management
•  Influence without authority
•  Integrity, adaptability and follow-through • Quality and preventive-care improvement
•  Adoption of sustainable workflows
•  Accurate, timely care-gap reporting
•  Improved documentation and data integrity
•  Resolution of EHR/reporting barriers
•  Provider and practice engagement

FLSA, Safety & Work Environment

FLSA / Timekeeping: This position is hourly and nonexempt. The employee must accurately record all time worked, including remote work, required training, calls, emails, report preparation and compensable travel between work locations. Overtime requires advance approval; however, all hours actually worked must be reported and paid. Off-the-clock work is prohibited.

OSHA / Clinic Safety: The role does not provide direct patient care and is not expected to routinely handle blood, bodily fluids, specimens, medications, sharps or regulated clinical waste. The employee must follow each practice’s infection-prevention, personal protective equipment, emergency, workplace-violence and incident-reporting procedures and immediately report exposures, injuries, threats or unsafe conditions.

Hybrid Work & Physical Requirements: The employee must maintain a reasonably safe and ergonomically appropriate remote workspace. The role requires extended computer use, communication in person and virtually, walking through medical practices, regular automobile travel and occasional lifting or carrying of materials up to 20 pounds. Reasonable accommodations may be provided as required by law.