Inovalon

Director, Clinical Quality, Training, Oversight and Innovation

Bowie, MD · Director

No sponsorship$132k-$176kDetected 5 days ago

Product StrategyAuditingOperations ManagementEmployment LawICD-10Clinical TrialsClinical ResearchResearchLeadershipCommunication

About the role

Therefore, we focus on empowering them with data-driven solutions.
The Senior Clinical Quality Assurance Analyst is responsible for clinical oversight, training, and innovation across the enterprise.

Perform analysis of reviews and lead consolidation of findings for reporting to senior leadership and other key stakeholders;
Support clinical product implementations to include ensuring designated clinical projects and their respective stage of development is met on time, within budget, and according to written requirement specifications;
Maintain open lines of communication across the enterprise regarding on-going overread and quality activity as it relates to client and operations management;
Develop recommendations for process and technical changes; document changes as applicable;
Assist in resolution of client questions, concerns, and service issues working closely with other key stakeholders to create and execute action plans;
Support organization's cross functional teams using exceptional clinical and business skills;
Develop new policies, processes, and procedures in line with clinical and organizational expectations;

Minimum 2 years of ICD-10 diagnosis coding expertise (ideally 5+ years)
Minimum 2 years of HEDIS quality measure experience
Risk adjustment coding expertise
Hands-on experience with AI tools or AI training background
demonstrated ability to understand AI capabilities and limitations
5+ Years clinical nursing background
5+ Years with public programs (e.g., Medicare, Medicaid)
Applicants must be authorized to work in the United States as a condition of employment. (This is only applicable for US-based positions)
Hands-on experience with AI tools or AI training background; demonstrated ability to understand AI capabilities and limitations
Minimum 2 years of ICD-10 diagnosis coding expertise (ideally 5+ years); deep understanding of coding guidelines and their application
Minimum 2 years of HEDIS quality measure experience; understanding of HEDIS rules, regulations, and hybrid measure development
Risk adjustment coding expertise; understanding of risk adjustment methodologies and coding accuracy
5+ Years in healthcare plan quality improvement initiatives preferred

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.
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.

This position is not eligible for immigration sponsorship (e.g. H-1B, TN, or E-3).

This listing is sourced directly from Inovalon's careers page and normalized into a canonical job model.