Claims Quality Audit Director jobs in Vallejo, CA

Description

THE ROLE

Under the direction of the Executive Director Quality – NorCal, the Director Quality Improvement will be responsible for planning, designing, directing, and executing performance improvement work in alignment with the Value Triple Aim (Quality, Service and Cost Excellence). The Director will partner with Ministry physician, clinical and operational leaders to develop the infrastructure, reporting mechanisms and strategies to facilitate Performance Improvement and achievement of Providence system, divisional and ministry-specific goals and strategic initiatives. The Director will ensure the proper preparation and coordination of resources needed to achieve regulatory compliance related to the CMS COP Quality Assessment and Performance Improvement (QAPI) Plan and QAPI Annual Evaluation, and The Joint Commission standards, Co-chaired Quality Committee related to performance improvement, to include the collection, analyses, reporting and on-going monitoring of quality and safety data needed to meet accreditation requirements. Provides oversight of infection prevention, risk, accreditation, and regulatory activities.

ESSENTIAL FUNCTIONS

• Plans and manages implementation of all quality related initiatives that reduce risk, improve patient safety and overall quality outcomes for patients being served under the Santa Rosa Memorial Hospital license.
• Establishes a quality plan and review procedure annually that creates transparency from bedside to board.
• Establishes a patient safety program consistent with Providence high-reliability organization approach that is implemented and consistently sustained by leadership.
• Routinely reviews risk issues and identifies opportunities to implement change that reduces overall clinical and organizational risk.
• Assures compliance with regulatory and accreditation standards and integrates multiple requirements into performance improvements plans and initiatives.
• Aligns and supports team with infection prevention priorities and intervention to assure patient safety overall.
• Act as an agent on behalf of the best interests of the healthcare consumer; works to address special needs (e.g., disparities in care, health literacy, and patient safety), values and works to provide support and resources as needed.
• Analytic thinking and knowledge-based decision making: assesses multiple sources of data and information, identifies key interventions that address multiple needs, breaks problems down into parts or steps; (workflow) recognizes multiple layers of cause and effect; collects appropriate information to make decisions informed by available evidenced competencies and patient experiences and perspectives; values and supports transparency and works with a team based environment to sustainably implement change.
• Development of a knowledge-rich environment—supports continuous improvement/learning and transparency using the data available to support decision making (collection, record keeping, access) by using emerging technology and methods.
• Demonstrates sustainable progress on improvement priorities, and monitors & reports ministry progress to executive leadership, Medical staff, and Governing body.
• Act as primary resource for SRMH to Clinical Institute/Service Line leaders to provide and/or interpret data for decision making including VOA cost data, clinical outcomes, LOS, payment data from payors, and physician outcomes. Reviews mortalities, and other outcomes as needed and coordinates action plans with ministry leadership (CMO, CNO, department leadership, & NorCal Executive Director of Quality.)
• In collaboration with regional data analytics, ensures service line clinical institute leaders are knowledgeable and have access to actionable and timely data and oversight internal monthly reporting of key executive clinical institute metrics via quality report.
• Analyzing, trending, monitoring, and presenting data to core leaders, service line leaders, physicians, etc. and collaborating to drive improvement through developed action plans.
• Oversees the submission of outcomes data for different payor designations and programs, e.g., Blue Distinction, Anthem, etc.
• Oversees the submission and validation of quarterly nurse sensitive indicators to NDNQI and other nursing databases. Utilizes the clinical, operational and/or cost outcome reports, trends, and coordinates with the magnet coordinator to communicate progress to nursing leadership. In collaboration with Magnet coordinator routinely identifies appropriate data for Magnet Sources of Evidence.
• In collaboration with care experience leader evaluates impact of patient experience to CMS, US News, Healthgrades national programs. Provide oversight to development of Performance Improvement plan to improve these national rankings performance.
• Oversight of data analytics in collaboration with ministry specific leaders for specialty certification designation.
• Coordinate efforts with SRMH, South Division, system-level data teams to ensure all externally reported data are accurate and comprehensive at the time of reporting, including the review fallouts cases, and coordinates action plans as needed. Strategic oversight of organizational performance that is externally reported, ensuring escalation, leadership awareness and performance improvement strategies are implemented. (e.g., insurance payor quality metrics, CMS, national quality registries.
• Able to balance competing priorities and balance clinical, operational and financial goals. Able to make a business case for changes in process or product in collaboration with other disciplines so that mutual goals are met or potential consequences for changes requested by Quality and Patient safety are weighed and mitigated in advance.
• PI Program management must include ability to rapidly respond to shifts in regulatory and accreditation requirements or emerging science through a nimble adaptive management style. Performance Improvement (PI) – encompasses clinical outcomes, patient safety, environment of care safety, infection control, risk management, operational improvements, service quality and organizational regulatory and accreditation readiness.
• Considers the ethical implications of decisions; acts openly and transparently; develops a reputation as trustworthy/reliable.
• Ensures integration of the Hospital’s quality, financial, operational and strategic planning processes to facilitate house-wide focus and achievement of performance improvement priorities.
• Fosters a climate that facilitates clear, fast, open and accurate communication regarding Performance Improvement (PI) and outcomes at all levels of the organization, with the Board of Trustees, Medical Staffs, and with the communities we serve.
• Champions an organizational environment of education, learning, and organizational competencies at all levels using proven principles and tools for continuous assessment and achievement of Performance Improvement tactics and clinical outcomes.
• Assures that major decisions related to Performance Improvement and Clinical Quality takes into account their effect on the organization and the communities we serve.
• Demonstrates service excellence and positive interpersonal relations in dealing with others.
• Assures the standardization and consistency of quality performance improvement activities throughout the organization.
• Works collaboratively with risk management, patient safety, regulatory, and division executive directors to develop standardized processes and share “learnings” throughout the division, and Providence system.
• Facilitates the establishment of organization monitoring and evaluation of PI/patient safety activities using identified quality indicators, and maintains confidentiality of all information related to patients, medical staff, employees, and as appropriate, other information.
• Assists in the orientation and ongoing education and mentoring of leaders and caregivers in the quality performance improvement process in collaboration with regional PI team.
• Supervises the collection, assessment and presentation of information to facilitate the ongoing measurement of processes and outcomes.
• Assists, as necessary, in the collection of data for key quality performance indicators.
• Develops systems and processes to assure the reliability, accuracy and confidentiality of information used in the department functions.
• Works collaboratively with Risk Management, Patient Safety, and Infection Prevention on the integration of risk, patient safety, quality improvement and regulatory compliance.
• Collaborates with Executive Director of Quality to support Medical Staff leadership in the development and implementation of systems and processes to identify practice variations and opportunities for improvements in patient care processes and/or outcomes for the organization.
• Collaborates with Executive Director of Quality and the use of regional PI staff’s use of the performance improvement methodology to provide PI support to the organization.
• Works collaboratively with the Ministry Regulatory Program, physician, operational and clinical leaders to ensure ongoing survey readiness.
• Facilitates internal and external stakeholder dialogue related to their quality projects and needs.
• Establishes systems and resources that enable cross-functional analysis, internal and external benchmarking, and complex problem-solving across organizational boundaries.
• Collaborates with leaders and staff across the organization, and with other entities and the System office, in pursuit of best practice and effective communication of excellent outcomes to our community.
• Focus on supporting medical staff quality and peer review procedures to include OPPE.
• Responsible for the deployment of quality and patient safety reward and recognition.
• Ensures that staff possesses the appropriate knowledge and skills necessary to provide care and performance improvement appropriate to the age of the patients served.
• Ensures that staff is competent in assessing and interpreting age appropriate data about the patient’s status in order to identify age-specific needs and provide the care needed.

QUALIFICATIONS

• Master's Degree in clinical field (e.g. Nursing or equivalent)
• Training in change management, team dynamics and facilitation
• Training in performance improvement tools and techniques
• Upon hire: National certification in performance improvement (e.g., Lean Six Sigma, Green or Black Belt, and Certified Professional in Healthcare Quality-CPHQ) (preferred)
• 5 years in Performance Improvement
• 5 years of increasing responsibility in leadership/oversight of quality programs
• 3 years of experience with system initiatives or multi-hospital performance improvement collaborative
• Proficiency in knowledge of data management, data governance and clinical analytics (internal and external) as well as data presentation
• Proficient in Microsoft Office
• Excellent organizational skills especially when coordinating big projects, committees and special events
• Idea champion and effective change agent
• Strong interpersonal skills to work with all levels of employees, physicians and customers
• Ability to create strong business partnerships
• Strong facilitation and complex problem-solving skills
• Ability to maximize output to multiple deadlines, while maintaining a calm demeanor
• Demonstrated excellent verbal, written and presentation communication skills
• Expert knowledge of applicable accreditation and regulatory standards.

About Providence

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Check out our benefits page for more information about our Benefits and Rewards.

Requsition ID: 279262

Company: Providence Jobs

Job Category: Clinical Quality

Job Function: Quality/Process Improvements

Job Schedule: Full time

Job Shift: Day

Career Track: Leadership

Department: 7810 QUALITY ASSURANCE

Address: CA Napa 1000 Trancas St

Work Location: Queen of the Valley Medical Center

Pay Range: $75.49 - $121.51

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Check out our benefits page for more information about our Benefits and Rewards.