Senior Director Quality Alliance - Clinically Integrated Network, Independence, OH
SENIOR DIRECTOR QUALITY ALLIANCE-CLINICALLY INTEGRATED NETWORK
REQ #: 53862
LOCATION: INDEPENDENCE, OH
FACILITY: CC INDEPENDENCE WEST CREEK
PROFESSIONAL AREA: QUALITY
DEPARTMENT: CLINICAL INTEGRATION-QA
SCHEDULE: FULL TIME
Provide leadership of the Cleveland Clinic Health System Physician Organization, Cleveland Clinic Community Physician Partnership (CPP, a PHO which provides a variety of services to its physician members, including managed care contracting and group purchasing programs), and provide leadership of the Cleveland Clinic Employee Health Plan’s clinical management unit (a self-insured health plan providing clinical utilization management, care coordination, case management, and pharmacy management to its members) . The Senior Director is responsible for partnering with the Quality Alliance Board Chair to develop and implement the mission and strategy of the QA both business and clinical, and partnering with the Chief Medical Officer of the Employee Health plan to direct clinical activities of the health plan. The incumbent will have accountability for the Quality Alliance leadership and management of activities to engage the aligned physician practices, ensure data distribution and integrity, identification of new partnership opportunities, and will ensure adherence to all regulatory and compliance requirements. In addition, will partner to provide Employee Health Plan leadership and management of activities related to clinical policies and procedures, care coordination, case management, utilization management, pharmacy management, and other clinical activities.
- Provides leadership to the QA and EHP organization and staff.
- Responsible for developing and implementing QA’s mission, strategic plan, business plan, and budget.
- Prepares, attends, and presents to QA Board of Directors and other Committees. Responsible for QA expense budget.
- Ensures that all QA programs and services are in compliance with all regulatory agencies governing health care delivery and rules of accrediting bodies.
- Supports existing QA committees.
- Oversees implementation of medical record repository by a third party vendor.
- Prepares, attends, and presents to EHP Medical Directors and other Committees.
- Oversight of EHP data management, program development, and quality improvement for EHP clinical programs.
- Oversees the evaluation and reporting on clinical outcomes for both QA and EHP programs.
- Participates in the managed care contracting process.
- Develops and implements group purchasing programs.
- Represents QA in its relationships and business dealings with external organizations.
- Continue the operational support of the Messenger Model contracting process.
- Provides oversight for the Credentialing function.
- Provides oversight for the Provider Relations function.
- Establishes, secures approval and oversees operating policies and procedures for QA and for EHP.
- Other duties as assigned.
- Master’s degree in business, or a health care related field required. RN or CNP in addition preferred.
- Comprehensive knowledge of medical group operations, business planning, and business development sufficient of perform and supervise all aspects of the Clinical Integration program and activities.
- None required.
COMPLEXITY OF WORK:
- Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.
- Must be able to take appropriate action in a stressful environment.
- Ten years’ experience with a focus in inpatient hospital or medical group operations, or nursing with strong quality of care background.
- Comprehensive knowledge of medical group operations, business planning, and business development sufficient to perform and supervise all aspects of the Quality Alliance program and activities.
- Demonstrated ability to interact in a team environment, provide direction on project assignments as well as the ability to successfully manage multiple projects simultaneously.
- Demonstrated ability to develop strong, trusting relationships, both internally and externally in a complex environment.
- Ability to forge collaborative and productive relationships where there is overlap in roles, e.g., Market and Network Services, Human Resources, Enterprise Strategic Planning.
- Manual dexterity to operate office equipment.
- Ability to lift and transport 0-25 pounds.
- May require extended periods of standing, walking or sitting.
- Good visual acuity through normal or corrected vision.
- Follows Standard Precautions using personal protective equipment as required for procedures.
PERSONAL PROTECTIVE EQUIPMENT:
The policy of Cleveland Clinic and its system hospitals (Cleveland Clinic) is to provide equal opportunity to all of our employees and applicants for employment in our tobacco free and drug free environment. All offers of employment are followed by testing for controlled substance and nicotine. Job offers will be rescinded for candidates for employment who test positive for nicotine. Candidates for employment who are impacted by Cleveland Clinic’s Smoking Policy will be permitted to reapply for open positions after 90 days. Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic facility.
Cleveland Clinic is pleased to be an equal employment employer: Women/Minorities/Veterans/Individuals with Disabilities