Senior Manager, Quality & Safety Improvement, Clinical Quality Consulting (KFH/HP)

In addition to the responsibilities listed above, this position is also responsible for leading clinical quality and patient safety management programs including budgets and annual evaluations and revisions; providing consultation and education related to clinical quality and patient safety, accreditation, regulatory and licensing (AR&L), risk management, and infection prevention and control; overseeing all work of team on the evaluation, design, development, and implementation of evidence-based guidelines, principles, and/or programs related to area of work as well as to reduce variation in clinical practice and optimize patient outcomes; overseeing team on the collection, analysis, reporting, and presentation of clinical data to identify trends, outliers, and areas for improvement to inform short- and long-term strategy and project goals; developing education initiatives regarding the interpretation of compliance methods when preparing for regulatory reviews, the interpretation of regulatory requirements, and regional project goals; overseeing team during the monitoring, reporting, and developing mitigation plans for all occurrences which may lead to medical center liability; supporting the medical centers continuous survey readiness program to maintain compliance with regulatory standards; and developing collaborative relationships with applicable government agencies, regulatory agencies, and other organizations.

• Creates and advocates for developmental opportunities for others; builds collaborative, cross-functional relationships. Solicits and acts on performance feedback; works with leaders and employees to set goals and provide open feedback and coaching to drive performance improvement. Pursues professional growth; hires, trains, and develops talent for growth opportunities; strategically evaluates talent for succession planning; sets performance management guidelines and expectations across teams / units. Oversees implementation, adapts, and stays up to date with organizational change, challenges, feedback, best practices, processes, and industry trends; shares best practices within and across teams. Fosters open dialogue amongst team members, engages, motivates, and promotes collaboration within and across teams; motivates teams to meet business objectives. Delegates tasks and decisions as appropriate; provides appropriate support, guidance and scope; encourages development and consideration of options in decision making; fosters access to stakeholders.


• Manages designated units or teams by translating business plans into tactical action items; oversees the completion of work assignments and identifies opportunities for improvement; ensures all policies and procedures are followed; partners with key stakeholders and business leaders to ensure products and/or services meet requirements and expectations while aligning with departmental strategies. Aligns team efforts; builds accountability for and measuring progress in achieving results; assumes responsibility for decision making; fosters direct reports to resolve escalated issues as appropriate. Communicates goals and objectives; incorporates resources, costs, and forecasts into team and unit plans; ensures matrixed resources are fulfilling service or performance requirements across reporting lines. Removes obstacles that impact performance; identifies and addresses improvement opportunities; guides performance and develops contingency plans accordingly; influences teams and units to operate in alignment with operational and business objectives.


• Manages data collection and analyses to support quality improvement efforts 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; presenting and interpreting quality improvement metric reports to demonstrate improvements and effectiveness of quality improvement programs to a variety of technical and nontechnical senior management and key stakeholders; and serving as a technical expert to senior management by interpreting trends, potential errors, and other analyses, by facilitating discussions on problem resolution for data source analysis, and by advising on the integration.


• Manages 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; developing the processes for 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 developing the escalation process for high-risk issues and trends.


• Manages quality improvement performance metrics development, collection, and utilization at the facility level by: implementing 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 approved by senior management; and managing the 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: leveraging the application of advanced technology, methods, and tools to develop stakeholders capabilities for process improvements; integrating the use of advanced 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 related departments, such as Legal, Claims, Risk Management, Compliance, Service and Access, and Member Relations, to implement quality improvement processes to have consistent design and application of improvement methodologies.


• Serves as the subject matter expert for quality improvement processes and regulations for within departments, facilities, internal and external committees, and key stakeholders by: providing consultation on the interpretation and interaction of current policies, and how they interact with the current climate, and potential changes to regulations and legislation; leading committees, projects to influence decisions on the enforcement, development of policies or procedures of regulations and auditing processes; maintaining collaborative, results oriented partnerships to ensure and advice on organizational capability to remain compliant; empowering educational programs to raise awareness for current and changes in regulation requirement, internal concerns, and system/database usage; and identifying systematic barriers which cause issues and weighs practical, technical, and KP capability to develop corrective actions.


• Fosters and empowers continuous learning and stakeholder development through quality performance review processes by: developing 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, and standards for corrective action plans; presenting performance review reports at the region level to department managers; and identifying the need for special training and educational programs related to process improvement for quality improvement programs for department managers and senior management.