Clinical Quality Manager

Summary:
The Clinical Quality Manager is responsible for oversight of day-to-day activities of the Quality Department to ensure quality initiatives, CQI activities and other requirements of health center quality are met. The Clinical Quality Director embraces a team-based approach and utilizes the PDSA process to guide process improvement. The Clinical Quality Manager must be a strong advocate and champion for the elements of the Patient Centered Medical Home. The Clinical Quality Manager must support the Director of Clinical Quality in quality performance activities to ensure quality patient care.

Essential Duties and Responsibilities:

Leadership and Operations

• Reporting to the Director of Clinical Quality, the Clinical Quality Manager supports the quality team. This includes Case Managers and Wellness Nurses. The Clinical Quality Manager coordinates quality improvement activities and collaboratives to improve clinical quality/performance.
• Analyzes quality gaps within the organization, evaluates solutions, utilizes best practice guidelines to guide quality improvement activities.
• Supports hiring, evaluates, trains, and supervises the quality coordinator, case managers and wellness Nurses.
• Supports a team approach to quality solutions within the organization.
• Externally, participates in quality collaboratives that support improvements in overall patient outcomes.
• Works collaboratively with the Manager of Clinical Support and the Non-Clinical Support Manager to support quality patient care.
• Maintains communication with all quality team members as well as other department leaders/directors to ensure understanding of quality initiatives, UDS and PCMH requirements.
• Use nationally recognized population health methodologies to assist with development of annual quality plan.
• Collect and coordinates data for PCMH submission.

• Collaborates with the Director of Payer Relations and others on payer related quality measures to include HEDIS, ACO, CIN and any other activities and reporting.

Financial Management

• Works closely with the Director of Clinical Quality in forecasting and preparing annual budget.
• Helps evaluate financial decisions that affect quality initiative and incentive within the organization.
• Ability to understand the elements of the Performance Management Incentive Bonus Plan as it relates to scorecard calculations, NACHC percentages and program requirements.

Human Resources and Team Development

• Resolves department problems and openly communicates with quality staff to ensure high productivity and morale. Ensures that Leader Rounding activities occur regularly to ensure leader visibility and improve staff relations.
• Manages a quality team that includes care coordination and case management.
• Manages Performance Evaluation and staff relations for the Quality Team.
• Works closely with Human Resources in maintaining Employee Health issues including but not limited to immunizations and vaccinations.

Compliance, Quality and Performance Improvement

• Participates in maintaining organizational compliance with governmental regulations and industry requirements. Supports activities to maintain such compliance.
• Coordinates and leads quality improvement performance programs.
• Supports and participates in organizational risk management and corporate compliance programs.
• Assists with UDS tracking of quality metrics and performance improvement activities.
• Manages/tracks patient complaints.
• Supports team-based preparation for HRSA OSV reviews, review preparation, coordinating and follow-up.
• Maintains an understanding of Federal, State, and local laws and regulations that impact Grace Health's ability to provide patient care.
• Performs other related duties as assigned by the Director of Clinical Quality and the Chief Medical Officer.
• Communication: Conveys information accurately and efficiently. Written communication is direct, concise, and easy to understand.
• Decision-making: Gathers necessary information to make good and timely decisions. Uses sound judgment and instincts. Seeks direction from Leadership appropriately.
• Supporting/Assisting: Seeks opportunities to help others be successful in meeting goals. Demonstrates behaviors reflective of our mission when helping others.
• Planning/Priority setting: Organizes tasks and objectives in order of importance, timing, and predicted results. Works within measure able goals and outcomes.
• Problem solving: Works systematically to solve problems. Develops reasonable and timely resolutions.
• Initiative: Takes prompt action to accomplish objectives. Seeks to resolve problems without being asked. Seeks direction from Leadership appropriately.

Key Functions:

• Knowledgeable of clinical quality measures and preventive health maintenance recommendations.
• Educates patients, family members, and other staff members in these areas as needed.
• Understands and adheres to regulations for FQHCs and Primary Care Centers. Maintains a comprehensive working knowledge of community resources, payer requirements, and network services for target populations.
• Understands population health and works collaboratively with the health care team to promote health and wellness.
• Develops strong knowledge of our electronic medical record and reporting capabilities.
• Works intimately with IT staff and Patient Care Teams to improve quality outcomes.

Other Essential Duties and Responsibilities:

• Grace Health recognizes that managing patient care is a team effort involving both clinical and non-clinical staff. All employees must embrace a team-based approach to patient care and understand that each role is important to our success.
• Team members must demonstrate excellent communication and coordination skills to provide quality patient care.
• Care coordination includes communication with community organizations, health plans, facilities, and specialists.
• Care team members must understand and embrace the concept of population health management and proactively address the needs of patients and families served by the practice.
• Team members must demonstrate the skills and knowledge necessary to communicate effectively with vulnerable patient populations.
• Team members must participate in Continuous Quality Improvement (CQI) activities within the organization to ensure patients receive high-quality care.
• All team members will be involved in improving quality outcomes.
• Team members will participate in the review and evaluation of practice performance and help identify opportunities for improvement.
• Team members will participate in Grace Health's advocacy program.

General Duties:

• Follows all organizational policies and procedures, including administrative, clinical, quality assurance, and personnel policies.
• Maintains satisfactory attendance, including attendance at meetings and completion of assigned tasks.
• Maintains timely documentation of all work assignments.
• Maintains patient confidentiality.
• Routinely keeps the supervisor informed regarding attendance and job assignments.
• Demonstrates flexibility and the ability to multitask.
• Works effectively and efficiently.
• Works cooperatively with providers, administration, and peers.

Qualification Requirements:

To perform this job successfully, an individual must be able to support and advance Grace Health's mission while satisfactorily performing each essential duty. The requirements listed below represent the knowledge, skills, and abilities required for the position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.
Skills:

• Communication
• Computer/Technology
• Conflict resolution
• Customer service
• Team building
• Time management
• Critical thinking
• Leadership

Education and/or Experience:

• Degree in Nursing or other pertinent healthcare. Bachelor's degree preferred. Current license if applicable.
• Quality Management/performance improvement experience preferred.
• Community Health Center experience preferred.

Grace Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.