DaVita Director, Clinical Quality in LAS VEGAS, Nevada

Director, Clinical Quality

Description

SUMMARY

Quality Management & Performance combines talented individuals form many areas of quality, including HEDIS, CHAPS, and Accreditation. Our Goal is extraordinary performance that exceeds the expectations of the constituents, customers and members we serve.

CHARACTERISTICS

  • Responsible for quality and continuous improvement within the job scopesResponsible for quality and continuous improvement within the job scopes

  • Responsible for all actions/responsibilities as described in company controlled documentation for their positionResponsible for all actions/responsibilities as described in company controlled documentation for their position

  • Contributes to and supports the corporation’s quality initiatives by planning, communicating, and encouraging team and individual contributions toward the corporation’s quality improvement effortsContributes to and supports the corporation’s quality initiatives by planning, communicating, and encouraging team and individual contributions toward the corporation’s quality improvement efforts

SUPERVISORY

  • Contributes to a working environment that allows all employees equal opportunities for development, growth, and advancementContributes to a working environment that allows all employees equal opportunities for development, growth, and advancement

  • Conducts business in compliance with the corporation’s Code of Business ConductConducts business in compliance with the corporation’s Code of Business Conduct

  • Provides effective leadership and directs the work of subordinatesProvides effective leadership and directs the work of subordinates

  • Carries out supervisory responsibilities in accordance with the organization’s policies and applicable lawsCarries out supervisory responsibilities in accordance with the organization’s policies and applicable laws

  • Select staff, coach’s performance, and provides ongoing and timely communication regarding performance, training, and development opportunitiesSelect staff, coach’s performance, and provides ongoing and timely communication regarding performance, training, and development opportunities

ESSENTIAL FUNCTIONS

  • Establish and maintain a Quality Improvement Program that encompasses all government programs and commercial payorsEstablish and maintain a Quality Improvement Program that encompasses all government programs and commercial payors

  • Direct and provide oversight of performance improvement activities including both quality of care and serviceDirect and provide oversight of performance improvement activities including both quality of care and service

  • Prioritize recommendations develop and effectively lead and assist national quality improvement teams in improving health outcomes implementing business strategies and exceeding State and Federal regulatory requirements and national accreditation guidelinesPrioritize recommendations develop and effectively lead and assist national quality improvement teams in improving health outcomes implementing business strategies and exceeding State and Federal regulatory requirements and national accreditation guidelines

  • Develop and implement training programs designed to improve the performance of government programs in accordance with state and federal regulatory requirements and the company business planDevelop and implement training programs designed to improve the performance of government programs in accordance with state and federal regulatory requirements and the company business plan

  • Prioritize areas of business risk and incorporate into the strategy of quality improvement planPrioritize areas of business risk and incorporate into the strategy of quality improvement plan

  • Coordinate quality efforts between business segments to leverage strengths and ensure a collaborative approach to achieving efficiencies in improving outcomesCoordinate quality efforts between business segments to leverage strengths and ensure a collaborative approach to achieving efficiencies in improving outcomes

  • Develop, coordinate and lead corporate clinical quality initiatives necessary to meet the objectives of a government program Quality Improvement Program (QIP)Develop, coordinate and lead corporate clinical quality initiatives necessary to meet the objectives of a government program Quality Improvement Program (QIP)

  • Identify opportunities and best practices to standardize processes to improve efficiencies and health outcomes across all government and commercial payor programsIdentify opportunities and best practices to standardize processes to improve efficiencies and health outcomes across all government and commercial payor programs

  • Support implementation of CMS and State required clinical Performance Improvement and Quality Improvement Projects (PIP and QIPs) pertinent to all government and commercial payor programsSupport implementation of CMS and State required clinical Performance Improvement and Quality Improvement Projects (PIP and QIPs) pertinent to all government and commercial payor programs

  • Evaluate effectiveness of the Quality Program by organizing the delivery and evaluation of annual customer satisfaction surveys for government and commercial payor programsEvaluate effectiveness of the Quality Program by organizing the delivery and evaluation of annual customer satisfaction surveys for government and commercial payor programs

  • Act as a liaison with internal and external customers to improve organizational clinical quality, including HEDISAct as a liaison with internal and external customers to improve organizational clinical quality, including HEDIS

  • Monitor and respond to regulatory changes related to clinical quality, including CMS star-related activities that directly and indirectly impact the organizationMonitor and respond to regulatory changes related to clinical quality, including CMS star-related activities that directly and indirectly impact the organization

  • Recommend opportunities for performance improvement of government and commercial payor programs through the tracking and trending of aggregate data related to quality and performance metrics (HEDIS scorecards, report cards, and dashboards)Recommend opportunities for performance improvement of government and commercial payor programs through the tracking and trending of aggregate data related to quality and performance metrics (HEDIS scorecards, report cards, and dashboards)

  • Works with delegated health plan leadership to develop strategic initiatives as ongoing improvementWorks with delegated health plan leadership to develop strategic initiatives as ongoing improvement

  • Conducts or directs assessments and produces analysis documents to guide strategic planningConducts or directs assessments and produces analysis documents to guide strategic planning

  • Forms internal and external strategic relationships which will support program innovation, growth, expansion and the development of new programsForms internal and external strategic relationships which will support program innovation, growth, expansion and the development of new programs

  • Interaction with regulatory agencies, as needed, and senior managementInteraction with regulatory agencies, as needed, and senior management

  • Provides leadership to and is accountable for the performance and direction through multiple layers of management and senior level staffProvides leadership to and is accountable for the performance and direction through multiple layers of management and senior level staff

  • Provides guidance to local quality leads in each applicable geographic marketsProvides guidance to local quality leads in each applicable geographic markets

  • Assist the Chief Medical Officer nationally in program development and efficiencyAssist the Chief Medical Officer nationally in program development and efficiency

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Qualifications

EXPERIENCE REQUIREMENTS
  • Five years of more direct health plan and/or medical group quality management experience, including NCQA requiredFive years of more direct health plan and/or medical group quality management experience, including NCQA required

  • Managed health care industry experience requiredManaged health care industry experience required

  • Experience in preparing for and leading accreditation surveys requiredExperience in preparing for and leading accreditation surveys required

  • 3 or more years demonstrated experience leading projects, tasks, or staff required3 or more years demonstrated experience leading projects, tasks, or staff required

  • Able to travel up to 50% required region-wide, client sites and officesAble to travel up to 50% required region-wide, client sites and offices

EDUCATIONAL REQUIREMENTS

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  • 4-year degree or RN Required – advanced degree preferred4-year degree or RN Required – advanced degree preferred

  • Certified Professional in Healthcare Quality (CPHQ) preferredCertified Professional in Healthcare Quality (CPHQ) preferred

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KNOWLEDGE, SKILLS, ABILITIES
  • Knowledge of CMS and State Medicaid requirements requiredKnowledge of CMS and State Medicaid requirements required

  • Excellent communication and presentation skills for user with the executive levels and regulatorsExcellent communication and presentation skills for user with the executive levels and regulators

  • Clinical background preferredClinical background preferred

Primary Location NV-LAS VEGAS - 89119

Req ID: 336426