Quality Director

Director Quality Outcome & Regulatory Reporting

Are you passionate about quality and committed to excellence? Consider joining our Tidelands Health team. As our region's largest health care provider, we are also one of our area's largest employers. More than 2,500 team members at more than 70 Tidelands Health locations bring our healing mission to life each day.

The Quality Outcome and Regulatory Reporting Director collaborates with organizational executives, SBU/CSC leaders, operational managers, and payor-relations teams to analyze clinical data and synthesize clinical and population-based approaches to disease prevention and health promotion. Interface and develop relationships with targeted payors and key employees to implement value-based contracting and ensure compliance with relevant quality program requirements. The director is responsible for managing and facilitating access, clinical synthesis, distribution, and analysis of internal and comparative data to support enterprises-wide strategic, operational, and quality projects.

Additionally, they analyze and study implementation procedures for improvement, working with program specialists as necessary to develop more effective procedures. The director coordinates with appropriate staff to implement changes that ensure the highest standards of quality and regulatory compliance within the organization. They also consult on, monitor, and measure the outcomes of various population and disease-based, quality, and payor-related programs.

Furthermore, the director collaborates with team members and leaders to execute strategies for improvement in care coordination, bundled payments, payor incentive programs, and other integration strategies. They maintain individual competence, conduct competency and annual performance evaluations for assigned employees, and provide consultation in their area of expertise to management, staff, and other disciplines. The director also performs scheduling and payroll functions for the department staff.

What you will do

• Develop and implement strategies to enhance the quality of patient care, improve clinical outcomes, and ensure compliance with regulatory standards. Assist the Primary Care Leadership and team in attaining strategic objectives, including but not limited to the implementation of the Patient-Centered Medical Home model of care and the attainment of Diabetes Recognition Program Certification.
• Lead a team of quality analysts, regulatory experts, and process improvement specialists to drive continuous improvement initiatives across the healthcare system. Lead cross-functional teams to design and implement process improvement initiatives aimed at optimizing clinical workflows, reducing operational inefficiencies, and increasing revenue generation opportunities. Provide guidance and support to departmental leaders and staff members in understanding and adhering to regulatory requirements and quality improvement standards.
• Collaborate with clinical and administrative departments to establish performance metrics and key performance indicators (KPIs) that align with quality improvement goals and revenue growth objectives. Collaborate with the Data Analytics team to develop and maintain the pertinent data in PowerBI reports, effectively communicate metric performance throughout the organization. Prepare and present reports on quality outcomes, regulatory compliance, and process improvement efforts to executive leadership and relevant stakeholders.
• Oversee the collection, analysis, and interpretation of data related to clinical quality and regulatory compliance to identify trends, patterns, and areas for improvement. Monitor and evaluate the effectiveness of process improvement initiatives by tracking key metrics, analyzing data, and conducting regular performance reviews.
• Create and sustain a resilient regulatory reporting framework, meticulously ensuring the precise and punctual submission of essential reports to various regulatory agencies and accrediting bodies. This encompasses pivotal programs such as the Inpatient Quality Reporting Program, Outpatient Quality Reporting Program, Joint Commission reporting, Ambulatory Surgery Center Reporting Program, Merit-Based Incentive Payment System, and the Promoting Interoperability Program.
• Establish strong relationships with external regulatory agencies, accrediting bodies, and all payors to stay updated on industry trends, changes in regulations, and best practices. Serve as a liaison between the healthcare system and external auditors or inspectors during regulatory audits, assessments, and surveys. Act as the designated quality liaison with MUSC, ensuring the comprehensive development of all essential quality and HEDIS metrics for the organization both during the Epic go-live phase and in the subsequent phases.
• Collaborate with finance and revenue cycle management teams to identify opportunities for revenue enhancement through improved coding accuracy, claims processing, reimbursement strategies, and optimization of all payor contracts and incentive programs.
• Develop and deliver training programs and workshops to educate staff, providers, and management about regulatory compliance documentation, quality metric workflows, and revenue optimization strategies.
• Analyze and comprehend intricate regulatory mandates, collaborating seamlessly with the IT department to guarantee that the system configuration remains aligned with the dynamic landscape of evolving regulations.
• Direct Supervision of all designated personnel, encompassing tasks such as scheduling, payroll management, conducting competency assessments, and facilitating opportunities for professional growth and development.

Education Qualifications

• BSN Required
• Master's Degree Preferred

Experience Qualifications

• Minimum of two years of quality management experience, including ongoing review, assessment, and education of staff, as well as policy and procedure management Required
• Minimum of two years of demonstrated experience in translating evidence-based guidelines from standard bodies into clinical practice, and knowledge of publicly reported quality evaluation programs Required
• Experience with the development and production of reports and documentation for review by various levels of both clinical and administrative management Required
• Experience in creating and managing collaborative multidisciplinary teams of healthcare professionals Required

Skills and Abilities

• General knowledge of coding, care management, and electronic medical record systems
• Working knowledge of clinical quality guidelines, along with experience researching updates and changes
• Demonstrated ability to explain evidence-based care concepts to clinical and administrative management
• Expert-level knowledge of payor-derived value-based contracting metrics and structure
• In-depth knowledge of quality management principles, methodologies, and tools
• Effective leadership, including staff management, interpersonal skills, team building, and consensus decision-making
• Strong written, verbal communication, and presentations skills
• Data management and analysis that drive change and improvement
• Strong analytical and operational problem-solving and critical thinking skills, with the ability to be innovative and decisive when required
• Self-motivated to complete enterprise-wide projects and seek out the information necessary to achieve departmental goals
• Ability to manage multiple tasks and prioritize work to adhere to deadlines and identified time frames
• Effective teaching skills translating significant regulatory requirements into understandable clinical and administrative actions
• Works with payors and internal stakeholders on clinical and operational strategies to improve care delivery

Licenses and Certifications

• Registered Nurse - South Carolina Department of Labor, Licensing and Regulation Required
• Basic Life Support Certified - American Heart Association Required
• Certified Healthcare Safety Professional - International Board for Certification Services and Management Certified Professional in Healthcare Quality (CPHQ Preferred

Physical Demand Light Physical DemandThe intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a contract for employment nor a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform tasks other than those specifically presented in this description.Tidelands Health is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.