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Kaiser Permanente Careers

Quality Assurance, UR & Case Management

Passion + Vision + Integrity = Excellence

Ensure consistency and the highest ethical standards across our entire organization. Our quality assurance team drives ongoing improvement by fostering an environment of support, providing technical and specialized consultative services, and inspiring ongoing excellence.

Medicaid Quality Program and Regulatory Lead

Location: Portland, OR Job Number: 923094 Date posted: 01/14/2021

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Serve as the KPNW Regional Quality Improvement Program Manager. Provide planning, leadership, & management of health plan quality assessment & performance improvement (QAPI) activities, assure compliance w/ CMS regulatory & contractual requirements for quality improvement at both federal & state levels, & w/ other accreditation & regulatory agencies. Review & evaluate effectiveness of regional QI efforts & initiatives to improve the health & safety of KFHP members. Facilitate performance improvement through trending & analysis of data obtained from occurrence reports, satisfaction surveys, utilization data, & clinical data. Identify, initiate, & facilitate successful completion of performance improvement initiatives in partnership w/ KFHP, KFH, & NWP quality & service improvement leaders.

Essential Functions:
- Manage & facilitate a portfolio of multidisciplinary projects, initiatives, across the region to improve member care, service, & patient safety using appropriate performance improvement models, methodologies, & tools to address opportunities under the scope of KFHP Quality & Service & NWP Quality & Systems. These efforts are complex, varied, & carry significant risk/reward & visibility for the organization in terms of pay for performance as well as reputation. Analyze data (clinical, satisfaction, health outcomes, utilization, & other as indicated) to evaluate performance; determine & communicate/escalate organizational risk or impact of performance gaps or noncompliance; recommend regional strategies for improvement or resolution to department & organizational leaders, using innovative systems thinking & evidence based strategies where possible. Act as consultant & facilitator to implement improvement initiatives & strategies; ensuring that projects are well designed & coordinated to achieve results while allowing operational or business leaders to maintain process ownership. Perform complex problem solving & systems analysis; establish process & outcome measures of effectiveness; document efforts & results & create/submit reports in a manner to meet regulatory & accreditation requirements & to inform KPNW executive leaders. Communicate program & member needs; effectively influence w/out authority, build understanding & consensus among stakeholders at all levels of the organization & negotiate for needed resources to address barriers to improvement or program effectiveness. Prepare & submit documentation demonstrating compliance w/ external & internal regulatory & accreditation standards; prepare materials & reports for audits, & respond w/ appropriate corrective action plans to audit findings, ensuring these are designed to be effectively implemented & sustained. Act as content & subject matter expert for certain quality related requirements in the Medicare contract, including but not limited to value based incentive programs & patient safety event reporting & billing processes.
- Collaborate w/ regional & Kaiser Permanente Program Office partners on improvement initiatives. Lead the region's efforts to collaborate w/ community health partners (state & federal offices & quality improvement organizations or QIO) on voluntary or mandated projects.
- Collaborate w/ physicians, managers, directors, professional staff, & executive leaders in researching best practices & measuring, developing, & implementing strategies for achieving program excellence.
- This job description is not all encompassing.

Basic Qualifications:
- Minimum five (5) years of health care management experience in a health plan, hospital or ambulatory setting.
- Minimum one (1) year of experience in quality, regulatory or accreditation management, or patient safety in a health care organization.
- Experience with developing quality improvement projects.
- Bachelor's degree in a health care related discipline.
License, Certification, Registration
- N/A
Additional Requirements:
- Working knowledge of quality and patient safety principles.
- Competent knowledge of continuous quality improvement principles, tools and methodologies.
- Ability to collect, analyze, display, and report statistically meaningful performance data; proficiency in use of Microsoft Office.
- Excellent written and verbal communication skills.
- Analytical problem-solving skills that lead to effective process and system improvement.
- Demonstrated excellence and experience in project management, process mapping, and leading performance improvement.
- Ability to present quality performance information to a wide variety of audiences both within and outside of the region through public speaking as well as written communication.

Preferred Qualifications:
- Minimum five (5) years of health care management experience in a hospital or managed care ambulatory setting.
- Minimum two (2) years of experience in quality, regulatory or accreditation management, or patient safety in a health care organization.

- Master's degree in public health, health care administration, or other health care related discipline.
- CPHQ certification (Certified Professional in Health Care Quality).

  • Experience with Medicaid Coordinated Care Organizations (CCOs) (for
    example: Health Share of Oregon, PacificSource, Molina), State Health Plan,
    State Healthcare programs, or Public Health department.

  • Experience with Health Plan quality program regulatory requirements
    and accreditation management.

Primary Location: Oregon,Portland,Kaiser Permanente Building Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri, Sat, Sun Working Hours Start: Varies Working Hours End: Varies Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: NUE-NW-01|NUE|Non Union Employee Job Level: Individual Contributor Job Category: QA / UR / Case Management Department: Quality Resource Management Travel: Yes, 5 % of the Time Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.

Learn About QA, Ur & Case Management Careers

Careers In QA, Ur & Case Management

As an organization, we are committed to delivering the same exemplary care no matter who you are, where you are, or what your needs. But how are those standards defined, measured, and assessed? That's where our quality assurance team comes in. Implementing the action plans and initiatives that will drive successful practices, you'll work across the organization to foster the necessary education, communication, and innovation that will enable us to operate as one KP — with our mission and goals in complete alignment.

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