Providence is calling a Regional Quality Management Director (Full Time / Day Shift ) to our Facey Quality/ Risk Management location in Mission Hills, CA.
The Regional QM Director is a key player ofthe Regional MSO leadership team, working in collaboration with the CMO andCOO's of the Medical Groups and Foundations. Accountable and responsible forcollaboratively leading, setting strategic direction, integration and deliveryof Quality Management MSO functions across all Medical Groups and Foundationsin compliance with delegated and regulatory requirements. Leads the integrationof MSO Quality Management programs, developing and implementing standardworkflows across multiple delivery models, local markets, and diversepopulations across the Southern CA market. Responsible for performance in theareas of QM related issues, data management/submission, Appeals &Grievances, ICE Reporting, CAPs, Pay for Performance/CMS 5 Star, PatientSatisfaction Survey process and reporting, CAPG Standards of Excellence Surveypreparation and submission as well as Committee functions such as Quarterly QIMeetings. Creates a scalable organizational structure to support growth,including acquisitions of patient populations and provider groups. Directs the overall Quality Management ofpatient services for risk bearing populations served by PHS CA ambulatory caremedical groups. Directs the oversight of reporting, compliance, efficiency andaccuracy of the QM process as delegated by each PSA with the health plans,including quality metrics management and reporting, event reporting, appealsand grievances, risk management and patient safety in the ambulatory setting,in accordance with our Program Plan, policies and procedures. Responsible foroverall design, budgeting and staffing for efficiency programs which serve theneeds of the patient populations across the ambulatory setting. Develops andimplements a robust set of actionable quality reports and tools such as the MDXRegistry and documentation of workflows to improve quality metrics and patientoutcomes, across the CA market and in alignment with Providence operatingcommitments and system-wide reporting such as MACRA. Instrumental in developingand implementing tools to improve accountability and patient safety, such asHigh Reliability Organization (HRO) and "Own It" programs. Responsible for compliance with health plans/NCQA/DMHChealth care quality mandates and for the preparation and submission of auditsand required health plan reports. Collaborates with Providence Health andServices (PHSCA) Medical Groups and Foundations leadership on all auditsresults and needed corrective action plans. Effectively drives consistent high qualitycare delivery in a rapid growth environment and across multiple ambulatory caredelivery systems (employed, contracted and IPA) and various risk levels. Leadsintegration across the Ambulatory Network and transition to value basedoperations and population's health, working closely with Medical Groups andFoundation COO's to align operations and to create synergies across thenetwork. Drives rapid process improvement to increase organizationalefficiency. Effectively uses data to evaluate opportunities, supportinterventions and measure results. Instrumental in the evaluation, selectionprocess and implementation of technology solutions to support QM functions.Leads organizational and cultural transformation, and inspires others to createhighly effective teams. Experienced leader who is able to inspire others, andhighly effective in both lateral/partnership/matrix and traditionalhierarchical reporting structures. Works closely on system-wide initiativesacross Providence St. Joseph Health and Services, sharing and implementing bestpractices and implementing system-wide initiatives in California, in caredelivery and quality data reporting. Demonstrates effectiveness and ability towork in partnership across reporting and organizational structures, includinghospitals, partners and medical groups in Southern CA and across the ProvidenceSt. Joseph Health organization.
Required qualifications for this position include:
Master's Degree in Health Care related field, Nursing, Health Administration, MBA or related discipline required.
2-4 years of clinical/operational leadership experience that provided the opportunity to manage a variety of patient care services in a complex healthcare environment required; 5 years experience preferred.
Strong communication skills as well as excellent clinical knowledge and experience in a medical group setting.
Experience in developing educational programs and procedures required.
Expert knowledge and abilities to develop and implement programs focused at delivering high quality coordinated patient care.
Ability to interpret, analyze and utilize data to facilitate organization-wide improvement in operating efficiencies with a focus on care delivery.
Active knowledge of performance improvement principles, Experience in developing educational programs and procedures required.
Knowledge of state and federal regulations.
Must be an effective spokesperson for the Quality Initiatives with the ability to deal with organizational complexities and conflict. Must be a global thinker with long term planning experience.
Ability to work cooperatively with others to use appropriate strengths, knowledge and cooperation to improve performance.
Ability to see and understand whole systems and how elements within systems relate.
Ability to act and provide leadership throughout the change process and ability to sustain change.
Extensive knowledge of Microsoft office – Excel, Word, Outlook – including managed care software programs.
Preferred qualifications for this position include:
Current California RN license.
HMO and Health plan familiarity strongly preferred.
Certification in quality or risk management and/or in patient safety such as CPHQ Certification is preferred.
About the organization you will serve:
Facey Medical Group is a multi-specialty medical group with over 160 physicians providing care to the growing population in the North & East regions of Los Angeles & Ventura Counties. Twelve medical clinics, including two urgent care centers and dedicated women's centers, are located across the San Fernando, Santa Clarita and Simi Valleys. The group began as a single medical practice over 90 years ago. Facey is part of Providence Health & Services, an integrated, not-for-profit 5-state network of hospitals, care centers, medical clinics, affiliated services and educational facilities spanning from California to Alaska.
We offer a full comprehensive range of benefits - see our website for details
As people of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.
Providence Health & Services is the third largest not-for-profit health system in the United States. Providence employs more than 82,000 caregivers (employees) across a five-state area; AK, WA, MT, OR, and CA. Our facilities include 34 hospitals, 600 physician clinics, senior services, supportive housing and other health and educational services. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.