Quality Director

Under minimal supervision, the Associate Director of Quality carries out the day to day management and operations of the Quality Department managing staff and projects to accomplish its goals and objectives. This position is responsible for all quality of care complaints and grievances including timely processing, tracking data and analysis and presentation of outcomes and improvement efforts around trending issues. The Associate Director of Quality also handles all internal potential quality improvement issues, root cause analysis and or other assigned investigations. This position assist the organization by leading or participating projects and clinical programs designed to make care safer, promote effective coordination of care, promote preventive care, help communities support better health, reduce costs of care through utilization management, and promote person-centered care. This position is responsible for coordinating and implementing a broad range of collaborative activities among private and public entities to improve health and health care for all Medicare beneficiaries, Medicaid recipients/enrollees, Ryan White Grant clients, other third party payer clients and organizational Healthcare Centers nationwide. Quality and Performance Improvement Manages, completes and submits required analyses and reports to meet regulatory and accreditation requirements (e.g., Grievances, HEDIS, UM/CM Dashboard). Coordinates activities of internal departments, external partners, and external vendors for quality analysis and reporting. Collaborates with health care providers to develop and implement interventions designed to promote health and wellness and improve organizational performance based on trended results of data from Grievances and UM/CM. Provides technical support to the organization that includes but is not limited to: designing process maps, performing gap analysis, conducting root cause analysis, directing implementation of interventions, identifying and overcoming barriers, and instigating organizational culture change. Builds sustainable relationships with internal and external customers, utilizing knowledge and skills to provide references. Performs the functions required and maintains certification as the Facility Site Review Nurse. Prepares supporting documentation for accreditation, audits and surveys. Communicates/consults with healthcare providers to assist with advancing their quality improvement objectives. Communicates and works well on tasks with ancillary and ad hoc team members, partners and stakeholders to plan, facilitate, and execute improvement activities. Remains current and knowledgeable about new initiatives, including the healthcare environment, activities, tools, and techniques through research, training, education, and a variety of nationally recognized sources. Routinely, accurately and concisely, documents and reports on project status, onsite visit activities, provider activities, and barriers/solutions using appropriate company and/or reporting tools and databases. Collaborates with written reports, proposals, and project budgets. Completes QI Assessment annually. Dimensions of Practice Leads and directs the work of others. Supervise, mentor and develop staff and ensure appropriate, educational programs, orientation and training courses to maintain current and future competency. Leads large scale quality improvement program initiatives and major health outcomes improvement projects, facilitates continuous departmental (divisional) process projects and quality improvement activities to measurably improve the health of people living with HIV/AIDS Evaluates data needs and collaborates with Information Technology Department and other analytics teams to identify opportunities to support organizational goals. Designs, develops and implements solutions that address the identified opportunity. Assesses, reviews, and educates providers regarding the quality of care and services provided to their members through on-site assessments and data analysis. Provides assistance with the design, development and implementation of solutions which address opportunities identified by provider data or IHS staff for improvement. Participates in the annual update of quality improvement (QI) program description and QI work plan. Reviews documentation for compliance; audits processes; interviews appropriate management, and staff; assists with gap analysis and the development and monitoring of corrective action plans. Analytics and Informatics Defines required data needed and data validation for assigned projects in collaboration with IT or other appropriate resource such as a vendor. Produces accurate and appropriate displays of data to analyze trends and recommend action. Communicates data reports to appropriate committees. Leadership and Systems Thinking Demonstrates initiative in the review, comprehension and implementation of contracts and regulations that effect the deliverables required of the QI Department. Facilitates and implements quality improvement and evaluation initiatives. Facilitates and implements health analytics initiatives. Keeps abreast of national trends and is active nationally within the quality and performance improvement space. Contributes to a work environment where continuous quality improvement in service and professional practice are pursued. Policy Development and Program Planning Serves on committees involved in quality improvement, health improvement and policy development related to health informatics, health information exchange, quality improvement and/or accreditation. Write policies and procedures related to Grievances and manages their annual review and updating. Communication and Cultural Competency Delivers targeted, culturally appropriate information to help individuals and groups understand health promotion and disease prevention information, policies, and regulations. Maintains current knowledge of HIV/AIDS social and clinical issues and incorporates that knowledge into the quality improvement activities performed. Keeps National QI Director informed all status of all projects, initiative and programs and request direction and resources if needed. Other Assumes responsibility for own professional growth and development by pursuing education, participating in professional committees and work groups and contributing to a work environment where continuous improvements in practice are pursued. Attends a minimum of one HIV/AIDS related educational event per year. Supervisory Responsibilities Supervises the Grievance Process and Facility Site Reviews. Supervises the Quality Improvement Staff, as requested, by National Quality Director. Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Desired knowledge, skills & abilities include: Strong knowledge of accreditation, federal and state regulations/requirements. Strong analytical and problem solving skills Excellent verbal and written communications skills Excellent data analysis and reporting skills Team player who builds effective working relationships Ability to work independently and with others Medical coding knowledge Strong organizational skills Ability to effectively collect, analyze, interpret, apply and communicate clinical and administrative data (e.g., HEDIS OR Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position. Education and/or Experience Bachelor's degree or higher in nursing or appropriate science or related discipline Master’s degree in public health or related field preferred. Current RN license and specialty certification preferred (quality, infection control and/or patient safety). 1-2 years of healthcare experience. Knowledge of and experience with root cause analysis and quality improvement tools and techniques, customer service and culture change concepts. Experience specific to process improvement, database entry, and maintenance and report generation preferred. Knowledge of survey standards and requirements for state level managed care programs and CMS is preferred. Computer/Software Skills & Abilities To perform this job successfully, an individual should have competent skills in Database software; Internet software; Spreadsheet software and Word Processing software, Data Analytics. Language Skills Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. Mathematical Skills Very High Skills: Ability to work with mathematical concepts. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical solutions. Reasoning Ability Very High Skills: Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables. professional Computer/Software Skills & Abilities: To perform this job successfully, an individual has should have knowledge of Microsoft Office software. Certificates, Licenses and Registrations Certified by State of California as Facility Site Review Nurse. If not certified, will obtain certification within 6 months of hire. Preference given to Certified Professional in Healthcare Quality (CPHQ). If not certified, may be asked to obtain certification within 24 months of hire. 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