Clinical Quality Manager

Austin Regional Clinic•Austin, TX

51d

About The Position

The Clinical Quality Manager is responsible for implementation, management and oversight of clinical quality strategy initiatives both internally and across ARC's value-based contracts to improve quality and cost outcomes. Establishes strong collaborative relationships with payer partners to reach mutually defined cost and quality goals. Collaborates with other departments, healthcare systems, health plans and other organizations to develop, support and coordinate functions. Carries out all duties while maintaining compliance and confidentiality and promoting the mission and philosophy of the organization.

Requirements

High school diploma or equivalent. Bachelor of Science degree.
At least three (3) or more years of experience working in quality improvement, a managed care setting, or population health.
Previous management or project management experience, including experience engaging and collaborating with all levels of staff, multiple management levels including clinical teams, business leaders, and physicians.
Ability to understand opposing points of view on highly complex issues and to negotiate and integrate different viewpoints.
Ability to understand complex problems and to collaborate and explore alternative solutions.
Ability to have a strong attention to detail.
Ability to be a self-starter with a need for minimal intervention or supervision. Ability to clarify directions when needed to continue tasks.
Ability to multi-task and readily accept new responsibilities.
Excellent customer service skills.
Excellent computer and keyboarding skills, including familiarity with Windows.
Excellent verbal and written communication skills.
Ability to manage competing priorities.
Ability to align own actions with those of other team members committed to common goals.
Ability to work in a team environment.
Ability to be a self-starter with a need for minimal intervention or supervision. Ability to clarify directions when needed to continue tasks.
Ability to engage others, listen and adapt response to meet others' needs.
Ability to perform job duties in a professional manner at all times.
Ability to understand, recall, and communicate, factual information.
Ability to understand, recall, and apply oral and/or written instructions or other information.
Ability to organize thoughts and ideas into understandable terminology.
Ability to apply common sense in performing job.

Nice To Haves

Master's degree in healthcare related field.
Graduate of accredited nursing school.
Knowledge and experience with ACOs and/or experience related to value-based payment structures.
Knowledge of HEDIS and Medicare STARS measures, MSSP ACO requirements or other population health based programs.
Experience with clinical quality program administration.
Prior experience working with physicians and physician organizations.
Prior experience working with performance and quality improvement processes and project management.
Licensed Registered Nurse in State of Texas preferred.
Current AHA approved Basic Life Support (BLS) Healthcare Provider Cardiopulmonary Resuscitation (CPR) course completion card preferred.

Responsibilities

Oversees implementation of clinical and quality strategy of ARC's value-based contracts including collaboration with ARC's operational leads, payers and partners to achieve quality goals
Manages health plan clinical quality relationships and business operations.
Serves as clinical liaison with payer partners and ensures deliverables are met. Develops presentations/reports and participates in discussions to facilitate effective JOCs with payers.
Responsible for recruiting, coaching, motivating, scheduling, evaluating, and training employees.
Responsible for performance evaluations, disciplinary actions, staff training and development, promoting teamwork and fostering a positive work environment.
Assumes a leadership role in executing clinical projects including the implementation and management of new quality programs, quality measures, applications and new lines of business including new risk arrangements.
Leads coordination of performing and submission of ACO, HEDIS and Medicare STARS clinical abstraction and quality attestation process for all value-based health plans.
Attends Clinical Quality Committee, Pedi Clinical Quality Committee and Nursing Ops (if applicable) meetings regularly and participates on sub-committees as needed.
Identifies, analyzes and prepares evidence-based and clinically actionable materials for Clinical Quality Committee review and distribution on matters involving patient and employee health.
Researches clinical quality best practices, provides recommendations, and assists with implementation for all specialties with quality initiatives.
Develops and implements Population Health/Clinical Quality-specific written policies, protocols and programs, and monitors adherence to system-wide policies/standardizations.
Participates and directs continued development of ARC provider scorecards and integration into ARC practices.
Oversees quality metric performance and ensure goals and objectives are met.
Works with operational management and nursing leadership to develop cooperative processes to assure effective coordination on various quality improvement projects.
Tracks and monitors quality performance and engages in open and constructive dialogue with teams.
Defines methods for measuring program success and demonstrating program effectiveness in partnership with Clinical Analytics team.
Leads ARC Clinical Quality Committee activities, meetings and discussions with and between departments within the organizations.
Adheres to all company policies, including but not limited to, OSHA, HIPAA, compliance and Code of Conduct.
Regular and dependable attendance.
Follows the core competencies set forth by the Company, which are available for review on CMSweb.
Interviews prospective employees and communicates with Human Resources throughout the hiring process.
Performs other duties as assigned.