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Director of Quality Improvement, Bakersfield, CA


Kern Health Systems

Director

Bakersfield, CA

December 7, 2018


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Director of Quality Improvement

Kern Family Health Care, Bakersfield, California, United States of America Req #1285

Monday, October 8, 2018

We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will help us potentially place you in a position that meets your objectives and those of the organization. Qualified applicants are considered for positions without regard to race, color, religion, sex (including pregnancy, childbirth and breastfeeding, or any related medical conditions), national origin, ancestry, age, marital or veteran status, sexual orientation, gender identity, genetic information, gender expression, military status, or the presence of a non-job related medical condition or disability (mental or physical).

Definition

Under the direction of the KHS Chief Medical Officer and the Administrative Director of Health Services, the Director of Quality Improvement will oversee and participate in activities related to quality improvement for the organization and membership by monitoring, assessing and improving performance in ambulatory and inpatient health care delivery or health care related services. The Director will implement the KHS Quality Management Plan and communicate with contract providers regarding required studies and participation. Related duties will include ongoing data collection, medical record reviews, report writing, and collaboration and coordination with other KHS departments, as well as outside agencies.

Distinguishing Characteristics

This position is responsible for quality improvement, HEDIS reporting, health education and disease management functions for KHS. This professional will be responsible for ensuring compliance with the QI work plan, oversight of the design, implementation, analysis and dissemination of utilization and accessibility studies and member and provider satisfaction studies. The Director of QI will also be responsible for overseeing the production, analysis, and dissemination of contractually mandated reports. The Director of QI is also responsible for maintaining compliance with Medi-Cal contractual stipulations for Quality programs. Makes an effective contribution to KHS’s business planning and fiscal processes. Is clear about departmental objectives and resource requirements.

Keeps KHS’s quality plan “front and center”, reinforcing a shared sense of purpose throughout the organization. Takes a mentoring role and strongly encourages the growth of team members. Ensures that professional development goals are incorporated into team members’ annual performance objectives, and regular reviews progress towards attaining them.

Essential Functions

  • Designs and implements Quality Improvement programs that meet the goals of the KHS QI plan and complies with regulatory, contractual, and NCQA requirements.
  • Maintains responsibility for all activities of the Quality Improvement staff including policies, procedures, and operations.
  • Works in coordination with the Provider Relations Manager of Special Programs to develop grant programs;
  • Maintains overall direction and supervision for all ongoing and new projects for the QI program.
  • Provides leadership and support to QI staff involved in QI projects.
  • Annually updates QI policies and procedures with input from the Quality Improvement Committee.
  • Participates as an active member of plan committees requiring preparation, research, and follow-up as requested by the Chief Medical Officer.
  • Oversees credentialing processes and all HEDIS related activities.
  • Supervises quality of care investigations and reporting.
  • Represents KHS as the QI liaison for external subcommittees, behavioral health subcontractor, QI workgroups, etc.
  • Assists with interviews, selects, trains, develops and evaluates subordinate staff; provides input to Human Resources regarding disciplinary issues, as required.
  • Coordinates QI activities and data collection between KHS departments and KHS contracted providers.
  • Prepares the organization for review and the accreditation processes by monitoring of external contract providers and internal processes.
  • Contributes to the overall design of the Pay for Performance Incentive Program in collaboration with Provider Relations department.
  • Coordinates and conducts in-depth chart analysis, data collection, and report preparation.
  • Identifies and recommends the initiation of quality improvement studies related to multi-disciplinary quality issues and State required studies.
  • Designs and maintains monitoring systems for the collection of HEDIS data.
  • Develops targeted interventions to improve HEDIS results and QI initiative results.
  • Serves as staff support and resource to the Quality Improvement and Utilization Management Committee, the Physician Advisory Committee and other committees, as appropriate.
  • Assists in problem identification, data analysis, conclusions, recommendation, action-plan design, follow-up and tracking.
  • Implements and facilitate internal Quality Improvement studies and work groups for continuous improvement within the organization.
  • Performs other job related duties as required.
  • Adheres to all company policies and procedures relative to employment and job responsibilities.

Employment Standards

Education: Possession of a valid California R.N. license required; completion of a Master’s Degree in Nursing (MSN) or healthcare field from an accredited college or University or other relevant health care field REQUIRED. Certified Professional in Healthcare Quality (CPHQ) REQUIRED.

Experience: Experience in Quality Improvement program implementation, research design, data collection, medical record abstraction, and quantitative analysis of health data required. Previous experience in NCQA accreditation process REQUIRED Minimum of three (3) years staff and program management experience.

Knowledge of: Minimum of (5) five years managed care systems in a health maintenance organization (HMO). Applicable standards and regulation pertaining to quality improvement programs for the Department of Health Services, NCQA, and HEDIS data collection and analysis; study design methods; appropriate quality tools and applications.

Ability to: Plan, coordinate, implement, analyze data and report on quality improvement activities; prepare clear concise reports; maintain proper documentation and confidentiality; communicate effectively with contracting providers and agencies; educate and motivate individuals; delegate and supervise employees.

Other: Possession of valid driver’s license and proof of State required auto liability insurance. Required Travel Up to 20%

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.

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