Senior Manager, Quality & Safety Oversight, Clinical Quality Oversight (KFHP/H)

In addition to the responsibilities listed above, this position is also responsible for aligning and coordinating with the Board of Directors and facilitating the oversight of systems designed to monitor and ensure the quality care and services are provided at a comparable level to all members and patients across the continuum of care; coordinating efforts to resolve complex issues in quality improvement systems; providing strategic guidance on issues related to the organization meeting the standards established by regulatory agencies and accreditation organizations and meeting public expectations; identifying and integrating best practices for maintaining the integrity of systems related to the selection, credentialing and competence of physicians and other health care practitioners; establishing and implementing systems for granting or terminating clinical privileges, professional staff or medical staff or clinical staff membership, proctoring and continuing education; developing and encouraging the use of standardized and established processes for reviewing and approving medical staff or provider staff Bylaws, Rules and Regulations and amendments; and serving as a liaison for the oversight of systems of all contracted entities including but not limited to the Permanente Medical Groups. This role is also responsible for facilitating and leading the peer review process, committees, and forums through leading the gathering of direct information on hospital or health system performance; aligning comprehensive feedback across sources; and developing and communicating a development plan to address needs and solve problems.

• 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.


• Serves as the subject matter expert for clinical 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 and ensuring accountability for successful implementation of core priorities; fostering collaborative, results-oriented partnerships with practitioners, staff, and/or management across clinical and administrative roles to ensure and advise on organizational capability to remain compliant; empowering educational programs to raise awareness for current and changing regulation requirements, internal concerns, and system/database usage; and identifying systematic barriers which cause issues, and weighing practical, technical, and KP capability to develop corrective actions.


• Manages the quality of care complaints and review process by: directing the grievance meetings, cases, reviews, referrals, and other mechanisms by collaborating with key stakeholders, the ombudsman, and external regulatory services; responding to and directing the preparations of all documentation, records, and information requested for specific patient case reviews; managing the process flow of investigations and claims for red flags and areas of improvement; and monitoring critical quality improvement metrics, cases, quality care incidents, and near misses according to established protocols on a periodic basis.


• Manages risk management efforts by: leading corrective action plan for areas of improvement identified through utilization review, clinical records audit, claim denials, patient satisfaction surveys, and auditing surveys across departments and regions; enabling others to be compliant with internal and external polices, regulations, and legislation related to quality improvement by interpreting regulations into actionable actions; 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 process for escalating high-risk issues and trends to appropriate entity for resolutions.


• Manages the development of new clinical quality improvement programs by: developing relationships with departments, key stakeholders, and senior management to identify and develop new programs with guidelines, metrics, and operational definitions of quality improvement through qualitative and quantitative program evaluation, analyzing program performance, performance reviews, and peer/department review groups; serving as a subject matter expert for a variety of health concepts, regulatory requirements, and change management principles to develop programs which optimize clinical quality, safety, or health outcomes; and realizing strategic opportunities to develop KPs capacity as a learning organization, increasing capacity in areas such as video ethnography, patient-reported outcomes, and harvesting of best practices.


• Manages the systems, procedures, and forms to improve data management programs and utilizes data to monitor and improve performance of all worker and patient safety programs by: ensuring the quality improvement monitoring agenda for assigned departments and regions includes all aspects of data management and analysis of trends and patterns of practice; serving as a subject matter expert on statistical analysis for team members and management for conducting and interpreting quality improvement evaluations; developing the procedures for gathering and entering data from databases, vital statistics, hospital patient discharge data, claims, and other relevant health sources; and presenting and interpreting reports (e.g., infection control research, utilization reviews, population health needs analysis, patient satisfaction) in specified formats for internal and external stakeholders, and publishing results accordingly.


• Manages regulatory audits and survey efforts by: serving as the primary contact between applicable government, regulatory, and key stakeholders for onsite visits and evaluations; developing the procedures for preparing requested audit documentation, information, reports, and tools throughout the auditing process; reviewing prepared audit documentation, information, and reports for ad hoc and compels auditing; and leading and identifying areas of improvement for continuous survey readiness and monitoring activities to maintain compliance with regulatory standards and forecast potential needs.


• Manages the evaluation of the cost effectiveness, practicality, and appropriateness of medical care given to patients by: conducting routine case reviews with practitioners; developing and implementing the standard operating procedures for treatment for specific medical codes to ensure equal and timely access to care; overseeing current patient treatment plans to ensure patient needs are met in a timely manner and escalates concerns to key stakeholders; forecasting current and future population health needs, such as community health concerns, access to transportation, knowledge of rights, reducing no shows, and others, and developing projects to ensure those needs are met; and overseeing previous patient cases to identify areas of improvement for length of stay, type of treatment, and time of treatment, and escalating concerns and recommendations to the senior leaders.