Clinical Quality Advisor

Altais Health Solutions•San Francisco, CA

About The Position

The Clinical Quality Advisor directs and manages multi-departmental and cross-functional programs and projects, supports quality improvement initiatives, analyzes performance data, and develops improvement activities based on industry best practices. The role develops and implements departmental or cross-functional projects and initiatives, ensuring timely delivery and continuous improvement. It interfaces with internal and external customers on technical matters and program status to improve delivery and efficiency. The advisor supports initiatives addressing CMS Star Ratings, HEDIS, CAHPS, HOS, P4P, and other performance measures. Responsibilities include researching evidence-based practices and benchmarks, monitoring outcomes, applying rapid-cycle performance improvement methods, maintaining quality improvement program documents, and supporting training and quality improvement teams. The role translates data into findings and recommendations, prepares reports and presentations, tracks milestones and delivery plans, and participates in governance, committees, stakeholder workgroups, and audits. It independently manages projects under limited supervision, provides guidance and training to employees, and recommends process and system enhancements.

Requirements

Bachelor’s degree or equivalent experience.
Minimum 8 years of prior relevant experience in managed care quality improvement, care management, or clinical program management in a clinical or healthcare environment.
Experience in Managed Service Organization (MSO)/Independent Practice Association (IPA) or health plan population health management or quality.
Working knowledge of HEDIS, CAHPS, HOS, CMS Medicare Star Ratings, P4P programs, CMS quality withhold, Managed Care Accountability Set (MCAS), and NCQA Quality Improvement standards.
Specific licensing requirements may apply, such as LVN, RN, NP, PA, MSW, or CPhT.

Responsibilities

Collaborate with team members to develop targeted improvement activities based on outcome performance and industry best practices, supporting CMS Star Ratings, HEDIS, CAHPS, HOS, P4P, and other measures.
Research evidence-based practices, national and regional benchmarks, and industry standards, and integrate findings into quality improvement initiatives.
Monitor improvement activities through routine analysis of measure outcomes and provide actionable feedback to management.
Use and implement performance improvement methodologies, including rapid-cycle improvement, to support internal quality initiatives.
Participate in developing and maintaining annual quality improvement program documents and evaluations.
Support the development, upgrade, and delivery of quality improvement training and problem-solving tools for teams and stakeholders.
Support intradepartmental quality improvement teams, programs, projects, and initiatives, ensuring alignment with organizational goals.
Identify opportunities to improve external-facing quality initiatives through technology and internal process improvements.
Translate complex data into meaningful information, draw conclusions, and provide recommendations regarding performance gaps, program implementation, and outcomes.
Prepare reports, conduct data analysis, and create materials for committees and management.
Contribute to continuous improvement of programs and processes, achieve operational targets, and recommend system or process enhancements.
Monitor programs from initiation through delivery and organize interdepartmental activities to meet schedule and budget.
Represent programs in governance and interdepartmental forums; define and track milestones; maintain and report on integrated delivery plans in compliance with company methodology.
Independently manage projects under limited supervision and solve complex problems involving multiple issues or specialties.
Communicate with internal and external parties, influence operational policies and practices, and provide guidance, coaching, and training to employees.
Manage projects, delegate and review work as needed, and serve as a subject matter expert who briefs key stakeholders.
Lead and participate in cross-functional committees and external stakeholder workgroups supporting quality improvement initiatives.
Participate in audits as required and help develop and implement corrective processes to meet audit requirements and improve clinical performance, quality, and care management.