Clinical Quality & Performance Improvement Manager (Miami)

CLINICAL QUALITY & PERFORMANCE IMPROVEMENT MANAGER

Department:Quality

Reports To: Chief Medical Officer and Chief Quality Officer

Functional Area: Clinical Quality & Performance Improvement

Supervisory Responsibility: Clinical Quality Improvement Specialist

Primary Governance Alignment: Care Management Committee; QIC

Position Summary

The Clinical Quality & Performance Improvement Manager serves as Banyan's working lead for clinical quality measurement, performance improvement, population health quality, and structured improvement of clinical outcomes across applicable services.

The Manager is responsible for translating performance data into actionable improvement work. This includes identifying performance gaps, determining where focused intervention is required, designing and leading quality improvement initiatives, engaging clinical and operational leaders, monitoring intervention effectiveness, and escalating persistent performance barriers to the Chief Medical Officer and Chief Quality Officer.

This is a hands-on management position. The Manager is expected to directly lead significant clinical quality initiatives and performance reviews rather than functioning solely as a supervisor. Clinical and operational leaders remain accountable for implementing workflows and achieving performance expectations within their departments.

1. Clinical Quality Performance Management

• Maintain an inventory of organizational clinical quality measures, targets, accountable leaders, reporting frequency, and current performance status.
• Review performance for UDS, HEDIS, value-based, population health, CCBHC, and other assigned clinical quality measures at established intervals.
• Identify measures, sites, providers, populations, or workflows performing below target and determine whether formal improvement activity is required.
• Conduct direct performance reviews with clinical and operational leaders and clearly define required actions, owners, and follow-up dates.
• Distinguish data-quality concerns from true clinical-performance gaps and coordinate resolution with Quality Analytics, BI, IT, EMR vendors, or clinical leadership as appropriate.
• Escalate persistent or significant clinical quality gaps to the CMO and CQO and applicable clinical leadership.
• Conduct routine and targeted chart audits to validate compliance with UDS, HEDIS, value-based care, preventive care, and other clinical quality measure requirements.
• Review medical record documentation to identify care gaps, documentation deficiencies, workflow breakdowns, and opportunities for performance improvement.
• Validate numerator and denominator compliance for assigned clinical quality measures and collaborate with Analytics, Informatics, and Clinical Operations to resolve discrepancies.
• Develop and maintain provider-specific and site-specific audit findings, recommendations, and corrective action plans.
• Monitor implementation of corrective actions resulting from chart audits and evaluate effectiveness through follow-up review.
• Analyze audit trends and present findings to clinical leadership, committees, and providers as appropriate.

2. Provider Performance Improvement & Clinical Workflow Optimization

The Clinical Quality Manager is responsible for directly partnering with physicians, advanced practice providers, nursing/clinical leadership, and clinical support teams to improve performance on assigned clinical quality measures.

Responsibilities include:

• Meet directly with providers and clinical teams to review individual, site-level, and organizational performance on UDS, HEDIS, value-based, preventive care, and other assigned clinical quality measures.
• Translate measure specifications into clear, practical expectations for providers and clinical staff.
• Identify provider-specific and workflow-specific barriers contributing to performance gaps.
• Develop targeted improvement plans for providers, sites, or clinical teams performing below established goals.
• Teach and reinforce clinical workflows necessary to appropriately meet quality-measure requirements, including required screening, documentation, follow-up, referral, medication, coding/documentation, and other applicable workflow components.
• Conduct or coordinate provider and clinical-team education when measure specifications or required workflows change.
• Partner with clinical leadership to standardize workflows across providers and sites when variation is contributing to performance gaps.
• Conduct direct workflow observation when necessary to determine why established processes are not producing expected results.
• Use patient-level gap lists and performance reports to work directly with providers and care teams on closing identified care gaps.
• Establish follow-up periods after provider education or workflow intervention and evaluate whether performance improves.
• Identify when poor measure performance is related to workflow, documentation, data capture, provider practice, patient factors, or system configuration and route the issue to the appropriate responsible party.
• Escalate persistent provider-level performance concerns to the appropriate clinical leader when education, coaching, and workflow intervention have not resulted in improvement.
• Coordinate with Quality Analytics to ensure provider performance information used for improvement activities is accurate and actionable.
• Coordinate with IT/Informatics/EMR resources when clinical workflows or documentation tools require modification.

3. Quality Improvement Program & Methodology

• Establish and maintain a standardized organizational methodology for clinical quality improvement, including baseline measurement, defined aim, intervention, responsible owner, monitoring frequency, and outcome evaluation.
• Personally lead complex, high-priority, or organization-wide clinical quality improvement initiatives.
• Determine when a performance gap requires a formal QI project, focused workflow intervention, provider-level action, education, or other response.
• Ensure QI initiatives use measurable objectives and do not close based solely on completion of an activity.
• Evaluate whether interventions produce sustained improvement and modify strategies when results do not improve.
• Maintain a centralized portfolio of active clinical QI initiatives and their status.

4. UDS, HEDIS & Preventive Care Improvement

• Serve as the Quality lead for improvement activities related to UDS clinical measures and assigned HEDIS/value-based measures.
• Review measure performance with clinical leadership at an established frequency and identify priority opportunities for intervention.
• Partner with Quality Analytics/BI to validate measure definitions, denominator/numerator logic, source systems, and reporting concerns before launching interventions.
• Develop provider-, site-, or population-specific improvement strategies when performance variation is identified.
• Coordinate with care management, clinical operations, providers, and support teams to implement interventions.
• Monitor whether interventions improve measure performance and escalate unresolved workflow or accountability barriers.

5. Population Health, Care Management & Referral Quality

• Lead Quality improvement support for population health, preventive care, SDOH, care coordination, referral loop closure, and transitions-of-care performance.
• Use Care Management subcommittee findings and data to identify opportunities requiring structured QI intervention.
• Partner with accountable operational leaders to define measurable corrective or improvement actions.
• Evaluate effectiveness of interventions and recommend additional action when performance does not improve.
• Ensure Quality supports improvement methodology without assuming day-to-day ownership of care management or referral operations.

6. Clinical Workflow & Documentation Improvement

• Evaluate clinical workflows when performance data, audits, incidents, or regulatory findings suggest a process contributes to poor quality outcomes.
• Facilitate workflow mapping and root/contributing-factor review for clinical performance problems.
• Develop clear recommended workflow changes in collaboration with clinical and operational subject-matter experts.
• Coordinate implementation expectations with responsible leaders and establish measures to determine whether the workflow change is effective.
• Ensure clinical workflow changes are incorporated into training, tools, or policies when indicated.

7. Provider & Site Performance Review

• Establish a standardized process for reviewing provider- and site-level clinical quality performance when reliable data are available.
• Prepare focused performance summaries identifying measures below target, trends, and required actions.
• Conduct or facilitate performance discussions with clinical leadership and applicable providers.
• Document agreed improvement actions, accountable owners, and follow-up dates.
• Escalate repeated failure to implement agreed clinical quality actions through the appropriate leadership structure.

8. Clinical Quality CAPs & Improvement Actions <