Regional MSO Quality Management Director

STATUS: FILLED

Providence Health & Services Management Services Organization
Mission Hills, CA

Does the opportunity to work collaboratively with a management team that strives for excellence in providing superior quality of care appeal to you? Are you looking for a chance to contribute your talent, skills and creativity to a position with a dynamic, growing, highly regarded company? Would you enjoy having a positive impact on the lives of the people you serve? If so, Providence Health & Services Management Services Organization has an exciting opportunity for an experienced Quality Management Professional that you may want to consider!

COMPANY OVERVIEW

As the third largest not-for-profit health system in the United States, Providence Health & Services is committed to providing for the needs of its communities – especially for those who are poor and vulnerable across Alaska, California, Montana, Oregon and Washington.

The company operates 34 hospitals, 600 physician clinics, 22 long-term care facilities, 19 hospice and home health programs and 693 supportive housing units in 14 locations. Its health plan serves its caregivers and other large employer groups covering 513,000 members

Providence Health and Services Management Services Organization (MSO) exclusively services the patient care and management needs of its risk bearing Medical Groups through Facey Medical Group & Foundation, Providence Medical Associates & Providence Medical Institute.

The company is located on a campus of ambulatory medical services in Mission Hills, and Torrance, CA and routinely provides on-site services throughout LA County to more than 125.000 managed care HMO lives, across 9 health plans for Commercial, MAPD and Managed Care MediCal products.

A centralized service team provides Quality Management Services for the company’s PPO which is also actively involved in ACOs, Covered CA Exchange product management and a variety of innovations in care delivery and Medical Management in collaboration with leaders of Providence affiliated Medical Groups. The PHS CA Medical Groups represent more than 400 staff model and IPA physicians working with over 1,000 Medical Group network providers in the communities they serve.

 

POSITION SUMMARY

Working in collaboration with the CMO’s and COO’s of Providence Health & Services Medical Groups and Foundations, the Regional MSO Quality Management Director is a key contributor to the Regional MSO leadership team. The QM Director is a ccountable and responsible for collaboratively leading, setting strategic direction, integration and delivery of Quality Management MSO functions across all Medical Groups and Foundations, in compliance with delegated and regulatory requirements. In addition, this position:

• Leads the integration of MSO Quality Management Programs, developing and implementing standard workflows across multiple delivery models, local markets and diverse populations across the Southern CA market.
• Responsible for performance in the areas of QM related issues, data management/submission, Appeals & Grievances, ICE Reporting, CAPs, Pay for Performance/CMS 5 Star, Patient Satisfaction Survey process and reporting, CAPG Standards of Excellence Survey preparation and submission as well as Committee functions such as Quarterly QI Meetings.
• Creates a scalable organizational structure to support growth, including acquisitions of patient populations and provider groups.
• Directs the overall Quality Management of patient services for risk bearing population served by PHS CA ambulatory care medical groups.
• Directs the oversight reporting, compliance, efficiency and accuracy of the QM process as delegated by each PSA with the health plans, including Quality Metrics Management and Reporting, Event Reporting, Appeals and Grievances, Risk Management and Patient Safety in the ambulatory setting, in accordance with Program Plan, Policies and Procedures.
• Responsible for overall design, budgeting and staffing for efficient programs that serve the needs of the patient populations across the ambulatory setting.
• Develops and implements a robust set of actionable Quality Reports and tools such as the MDX Registry and documentation of workflows to improve Quality Metrics and Patient Outcomes, across the CA market and in alignment with PHS operating commitments and system-wide reporting such as MACRA.
• Instrumental in developing and implementing tools to improve accountability and patient safety, such as High Reliability Organization (HRO) and “Own It”.
• Responsible for compliance with health plan/NCQA/DMHC health care quality, and risk mandates and for the preparation and submission of audits and required health plan reports.
• Collaborates with Providence Health and Services (PHSCA) Medical Groups and Foundations’ leadership on all audits results and needed corrective action plans.
• Effectively drives consistent high quality care delivery in a rapid growth environment and across multiple ambulatory care delivery systems (employed, contracted and IPA) and various risk levels.
• Leads integration across the Ambulatory Network and transition to value based operations and population health, working closely with Medical Groups and Foundation COO’s to align operations and to create synergies across the network.
• Drives rapid process improvement to increase organizational efficiency.
• Effectively uses data to evaluate opportunities, support interventions and measure results.
• Instrumental in the evaluation, selection process and implementation of technology solutions to support QM functions.
• Leads organizational and cultural transformation, and inspires others to create highly effective teams.
• Experienced leader who is able to inspire others, and highly effective in lateral/partnership/matrix and traditional hierarchical reporting structures.

The Regional QM Director also works closely on System-wide initiatives across Providence St Joseph Health and Services, sharing and implementing best practices and implementing System-wide initiatives in California, in care delivery and quality data reporting and demonstrates effectiveness and the ability to work in partnership across reporting and organizational structures, including hospitals partners and medical groups in Southern CA and across the Providence St Joseph Health organization

ESSENTIAL JOB FUNCTIONS

The Regional Quality Management MSO Director serves as a resource for the Quality Management process across the PHSCA Medical Groups and Foundations and has responsibility for integration across the California Market for standards of care and enterprise Quality Management issues.

Performance Criteria

• Directs the overall Quality Management Services for risk bearing patient population within the Medical Foundations for PHSCA and the medical groups.
• Designs and implements Quality Improvement projects across PHSCA Medical Groups and Foundations.
• Ensures compliance and efficiency in achieving all metrics by designing staffing, budgeting and workflow to support Quality Management including Continuous Process Improvement, Data Collection and Reporting, Event Reporting.
• Analyzes, develops and implements interventions, systems of care, care transitions and reporting processes to support efficient care, optimize patient outcomes and total cost of care in the delivery system of all PHSCA Medical Groups and Foundations.
• Responsible for department policies and procedures, staffing and training.
• Responsible for data collection and reporting internally and externally.
• Develops and presents periodic reports, statistical information, proposals and other special reports as may be required.
• Maintains QM statistics/files in compliance with NCQA, managed care organizations and state/federal agencies. Ensures maximum confidentiality of such data.
• Provides aggregate analysis of Quality Data.
• Maintains statistical trending of Appeals and Grievances and other QM data.
• Identifies quality of care conditions and practices and evaluates their significance.
• Analyzes and prioritizes quality improvement activities.
• Designs, implements and maintains an Incident/Grievance Reporting System designed to identify occurrences with potential quality of care issues or for clinical risk issues.
• Oversees the Investigation and analysis of actual/potential quality risk issues in the group practices and in the medical foundations.
• Assesses liability and probability of legal action in collaboration with the Risk Management Department.
• Oversees the Quality Management staff that investigates, evaluates, and responds to customer (patients, patient relative, employees and visitors) complaints concerning all aspects of care delivery and business operations for PHSCA Medical Groups and Foundations.
• Ensures collection of all data necessary to prepare a response to complaints.
• Manages the response to patient complaints in collaboration with Risk Management, Human Resources, designated Operations and other required staff, with a focus on patient/employee service satisfaction.
• Takes steps to ascertain that quality issues and risks are minimized through follow-up and actions on all health plan regulatory audit report recommendations/deficiencies.
• Coordinates the investigation and development of health plan corrective plans. Responsible for submission of required reports to appropriate agencies.
• Develops and implements educational programs designed to raise employee awareness of Quality Management issues, promotes improved customer service to reduce frequency of complaints and grievances throughout PHSCA Medical Groups and Foundations.
• In partnership with PHSCA Medical Groups and Foundations administrative and medical leadership, designs and implements programs and protocols to improve patient care and satisfaction.
• Coordinates all activities for the yearly Pay for Performance Initiative. This includes all activities for participation in the annual Patient Assessment Survey (PAS) as well as the Clinical Measures and IT Systems Measures.
• Assists in the implementation of organization-wide Quality of Service / Quality of Care initiatives as appropriate. This includes participation in Quality Improvement Collaboratives as appropriate.
• Respects the dignity, confidentiality and privacy of patients through diligent awareness and monitoring of HIPAA compliance throughout all Dept areas and care areas where PHSCA QM employees are providing service.

EXPERIENCE & TRAINING

• 2-4 years of Managed Care clinical/operational leadership experience that provided the opportunity contribute and grow in a complex healthcare environment.
• 5+ years QI experience, preferably in an MSO, Medical Group/IPA or Health Plan.
• Strong communication skills as well as excellent clinical knowledge and experience in a medical group setting. HMO and Health plan familiarity strongly preferred.
• Expert knowledge and ability to develop and implement programs focused at delivering high quality coordinated patient care
• Ability to interpret, analyze and utilize data to facilitate organization-wide improvement in operating efficiencies with a focus on care delivery
• Active knowledge of performance improvement principles.
• Experience in developing educational programs and procedures required.
• Knowledge of state and federal regulations
• Must be an effective spokesperson for the Quality Initiatives with the ability to deal with organizational complexities and conflict.
• Must be a global thinker with long term planning experience.
• Ability to work cooperatively with others to use appropriate strengths, knowledge and cooperation to improve performance.
• Strong interpersonal skills, problem-solving skills.
• Ability to see and understand whole systems and how elements within systems relate.
• Ability to act and provide leadership throughout the change process.
• Ability to sustain change.
• Extensive knowledge of Microsoft office – Excel, Word, Outlook – including managed care software programs.

 

EDUCATION/LICENSURES

• Required: Masters Degree in Health Care related field, Nursing, Health Administration, MBA or related discipline.
• Preferred: Current, unencumbered California RN license.

The Regional Quality Management MSO will have an opportunity to make a significant contribution to the lives of Providence’s patient population and to grow with a company that offers a unique and compassionate approach to patient care. Share your enthusiasm, experience, and skills with a company that is on the cutting edge of innovative Healthcare in California!

 

For further information, please contact:

Mary Niccum or Susan Pisarik

Phone: 949.721.8250
Fax: 949.721.8259
Email: exec.search@esrg.com 

Disclaimer
The Job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The Employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change