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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.

Director Quality Performance & Reporting

Location: Renton, WA Additional Locations:
Job Number: 858534 Date posted: 01/13/2020
Description:

THIS POSITION IS RESPONSIBLE FOR LEADING A TEAM TO ASSURE KPWA IS ORGANIZED, PREPARED AND SUCCESSFULLY ACHIEVES QUALITY ACCREDITATION AS A HEALTH PLAN (NCQA, PCMH) AND FOR CARE DELIVERY FACILITIES (HOSPITAL, ASC, PROCEDURE CENTERS, AND OTHERS TBD).  LEADS (IN COLLABORATION WITH KEY STAKEHOLDERS) PREPARATION PROCESSES, IS EXPERT IN ACHIEVING ACCREDITATION STATUS, AND FACILITATES QUALITY REPORTING FOR QUALITY HEDIS AND CAHPS MEASURES ON BEHALF OF KPWA.  PROVIDES EXPERTISE IN ANALYSIS OF PERFORMANCE AND IDENTIFICATION OF PERFORMANCE GAPS.  ASSURES KPWA RESPONDS TO ALL EXTERNAL QUALITY REPORTING REQUIREMENTS AND ENSURES QUALITY COMMITTEE PROCESSES ARE ORGANIZED FOR KPWA UP THROUGH KP NATIONAL QUALITY COMMITTEE.

Provides leadership and strategic direction for regulatory, accreditation, delegated entities and internal quality performance oversight for KP Washington including the Health Plan NCQA and PCMH accreditation and facility accreditation for hospital, ASCs, Procedure Centers and others to be determined.  This position is accountable for ensuring corporate level enterprise compliance with quality review entities in partnership with executive leaders and their direct reports at KPWA.  Accountable for assuring development and oversight of strategies, tactics and action plans that ensure alignment, linkage and integration of KPWA quality programs and efforts with external quality requirements and regulations.

Essential Responsibilities:
  • Quality Accreditation: Leads the processes to initiate, plan, and execute internal and external performance reporting and auditing functions to determine accurate and reliable review readiness and identification of gaps for achievement of quality accreditation processes. Leads and develops processes to ensure compliance with quality delegated functions. Plans and leads preparation process, manages review and response for all external quality review for NCQA, Kaiser's MDQR, State and Federal purchasers' quality review. Oversees responses to requests for quality information from external entities: RFIs and RFPs in collaboration with department Executive Director.
  • Quality Reporting and Analysis: Leads the HEDIS Medical Review team to assure compliance with annual medical chart review processes to meet NCQA/HEDIS/CAHPS accreditation compliance.  Leads data analysis, development and revisions of various quality dashboards to support KPWA Senior leaders in evaluating and monitoring performance. Leads data analysis, literature and best practice reviews to identify opportunities for performance improvement in clinical settings for documentation and workflow to improve service and clinical population outcomes.   Assures quality reporting and committee processes are organized, documented and meet timeliness and regulatory requirements on behalf of KPWA.
  • Care Delivery System Facilities Accreditation: Leads accreditation and quality management program for Care Delivery system hospital, ASCs, procedure centers and others to be determined.  Ensures that WPMG/KPWA meets the Meaningful Use reporting requirements.  quality accreditation and reporting processes to assure quality regulatory processes are met for hospital system, ASCs, Procedure Centers and others to be determined.  
  • Quality Management: Responsible and accountable to continuously evaluate quality program structure and processes to ensure alignment with external review requirements and delegated functions and include aspects of quality such as clinical, service, voice of purchaser, credentialing and care management.  Uses this information to collaborate with KPWA leadership to assure the development and oversight of regional level strategies, tactics and action plans to achieve quality goals.  Accountable for identifying organizational gaps through internal/external review processes.  Leads discussion with organizational leaders in the prioritization and decisions to close identified gaps.
  • Management: Leads and manages several work teams to assure skills and competencies are developed, cross functional capabilities are optimized and team goals are organized to support the achievement of the organization's quality goals and targets.
  • Basic Qualifications:
    Experience
  • Minimum five (5) years of experience in health care administration.
  • Education
  • Master's degree in nursing or heatlh related field.
  • License, Certification, Registration
  • N/A

  • Additional Requirements:
  • Demonstrated experience related to regulatory compliance, quality improvement.
  • Proficiency in communication, excellent writing and verbal skills.
  • Knowledge of quality improvement methodology and analytic expertise, ability to understand and interpret quality performance data.
  • Demonstrated leadership experience and ability to collaborate with others and lead/direct complex projects.
  • Project management, facilitation and excellent organizational skills.

  • Preferred Qualifications:
  • Three (3) years leading quality improvement and/or accreditation and regulatory compliance work for Health Plan and/or health care facilities.
  • Master's degree in nursing.
  • Primary Location: Washington,Renton,Renton Administration - Glacier 1200 SW 27th St. Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon-Fri Working Hours Start: 8:00 AM Working Hours End: 5:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Salaried, Non-Union, Exempt Job Level: Director/Senior Director Job Category: QA / UR / Case Management Department: Quality Travel: Yes, 25 % 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.

    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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