Medi-Cal Quality and Safety Improvement Consultant VI, Statewide Coordination Lead

Drives a broad range of administrative, facilitation, and technical support functions in the area of Quality and Safety Improvement to coordinate and develop multiple Quality and Safety programs and initiatives. Leverages advanced knowledge and technical expertise to develop, implement, monitor, and continuously improve multiple Quality and Safety programs and initiatives with high organizational impact. Develops, monitors, and oversees performance indicators and metrics for several improvement projects, collaborates across multiple departments to collect, analyze, and trend data from multiple reporting systems and sources to identify opportunities and create plans to improve quality and safety, decrease risk, and maintain the KP safety culture. Develops and coordinates across workgroups to address priority issues and acts as a resource for issues related to quality and safety. Supports multiple committees that are coordinated or chaired by the department. Oversees and ensures organizations compliance with professional standards, laws and regulations, and internal requirements related to quality and safety.

• Promotes learning in others by communicating information and providing advice to drive projects forward; builds collaborative, cross-functional relationships. Solicits and acts on performance feedback; provides actionable feedback to others, including upward feedback to leadership; influences, mentors, and coaches team members. Practices self-leadership; creates, evaluates, and responds to the strengths and weaknesses of self and unit or team members. Leads the adaptation to competing demands and new responsibilities; adapts to and learns from change, challenges, and feedback. Fosters open dialogue amongst team members.


• Drives the execution of multiple work streams by identifying member and operational needs; translates business strategy into actionable business requirements; develops and updates new procedures and policies. Gains cross-functional support for objectives and priorities; determines and carries out processes and methodologies; solves highly complex issues; escalates and resolves issues as appropriate; sets standards and measures progress. Develops work plans to meet business priorities and deadlines; coordinates, obtains and distributes resources. Removes obstacles that impact performance; guides performance and develops contingency plans accordingly; influences the completion of project tasks by others.


• Develops advanced data collection and analyses to support quality improvement reporting by: overseeing statistical analysis for quality improvement evaluations, special projects, and other work for multidisciplinary review; integrating multiple utilization data reporting systems to develop and maintain a variety of statistical reports in a format which enables care providers to see variations in practice patterns that adheres to specified formats by department, facility, and region standardized templates; presenting and interpreting quality improvement metric reports to demonstrate improvements and effectiveness of quality improvement programs to a variety of technical and nontechnical audiences at the senior management level; and serving as a technical expert to senior and executive management by interpreting results into actionable plans and resolving issues related to data analysis and storage and advising on integration into strategic goals.


• Investigates opportunities to improve quality improvement and improvement risk management efforts by: leading corrective action plan for areas of improvement identified through utilization review, clinical records audit, claim denials, member satisfaction surveys, and auditing surveys across departments and regions; ensuring process improvements are compliant with established internal and external regulation requirements at the local and state level; consulting with key stakeholders on the interpretation of root cause analysis, failure mode and effect analysis, and other assessments in response to significant events, near misses, and good catches in order to identify areas of improvement and evaluate newly internalized processes and programs; and driving escalations of high-risk issues and trends to appropriate entity for resolutions.


• Provides technical advice throughout the lifecycle of quality improvement performance metrics development, collection, and utilization at the facility and regional level by: investigating the integration of best practices in the development of performance metrics, standards, and methods to establish improvement success; consulting with multiple stakeholders, often with competing/conflicting objectives, to ensure development of cohesive and reachable metrics are practical, meet multidisciplinary standards, and are in line with KP capability; and designing and implementing the complex delivery of measurable results and alignment with strategic objectives by integrating metric utilization into workflows, and providing expertise in the development of project structure, charters, metrics, and work agreements throughout the project lifecycle.


• Directs the development of multiple quality improvement initiatives by: researching new and leveraging current technology, methods, and tools to develop stakeholders capabilities for process improvements which are effective and cost effective; identifying and establishing the standards for the use of new data-driven improvement principles, tools, and problem-solving methods, including Lean/Six-Sigma concepts and techniques using quality improvement metrics; synthesizes key information and works to break down issues into logical parts for the creation of milestones, detailed workplans, and documentation practices in order to create a clear, logical, and realistic plan; and consulting with key stakeholders, such as department Chiefs and Clinical Campions and Managers, to developing new quality improvement processes to have consistent design, application of improvement methodologies, and use of technology.


• Serves as the technical subject matter expert for quality improvement processes and regulations for senior and executive stakeholders, business owners, and team members at the regional and organization level by: providing consultation on the interpretation, interaction, and implementation of current policies, regulations, and legislation and advises on the current climate and potential changes which may have long term effects on business capability; maintaining collaborative, results oriented partnerships to ensure compliance with regulations and improve patient safety, maintain the KP safety culture, reporting accuracy, and health outcomes current and future compliance and advises on current and future KP capability to be continuously adaptive and compliant; presenting and interpreting quality improvement metric reports to demonstrate improvements and effectiveness of quality improvement programs to a variety of technical and nontechnical audiences; proactively engaging internal and external quality improvement committees, projects, and relevant initiatives to actualize change at the state/regional level; and identifying systematic barriers to process improvements issues and weighs practical and technical considerations in addressing issues and recommends corrective actions.


• Fosters and empowers continuous learning and stakeholder development through quality performance review processes by: developing new utilization and performance reviews processes at the regional level by utilizing multidisciplinary criteria and guidelines, and takes a systematic approach to quality improvement; developing the standards for performance areas of improvement for at the facility/state level, provides feedback and coaching as needed, standards for corrective action plans; presenting performance review reports at the regional and organizational level to senior and executive management, and advises on the integration of best practices; and developing new curriculum and special training and educational programs related to process improvement for quality improvement programs for department managers and senior management.