Senior Manager, Quality & Safety Oversight, Clinical Quality Oversight (KFHP/H)

Kaiser Permanente • San Diego, CA

67d

About The Position

In addition to the responsibilities listed above, this position is also responsible for aligning and coordinating with the Board of Directors and facilitating the oversight of systems designed to monitor and ensure the quality care and services are provided at a comparable level to all members and patients across the continuum of care; coordinating efforts to resolve complex issues in quality improvement systems; providing strategic guidance on issues related to the organization meeting the standards established by regulatory agencies and accreditation organizations and meeting public expectations; identifying and integrating best practices for maintaining the integrity of systems related to the selection, credentialing and competence of physicians and other health care practitioners; establishing and implementing systems for granting or terminating clinical privileges, professional staff or medical staff or clinical staff membership, proctoring and continuing education; developing and encouraging the use of standardized and established processes for reviewing and approving medical staff or provider staff Bylaws, Rules and Regulations and amendments; and serving as a liaison for the oversight of systems of all contracted entities including but not limited to the Permanente Medical Groups. This role is also responsible for facilitating and leading the peer review process, committees, and forums through leading the gathering of direct information on hospital or health system performance; aligning comprehensive feedback across sources; and developing and communicating a development plan to address needs and solve problems.

Requirements

• Minimum one (1) year of experience managing operational or project budgets.
• Minimum five (5) years of experience in a leadership role with or without direct reports.
• Minimum four (4) years of experience with databases and spreadsheets.
• Minimum four (4) years of experience delivering training programs.
• Minimum five (5) years of experience in clinical setting, health care administration, or a directly related field.
• Bachelors degree in Business Administration, Health Care Administration, Nursing, Public Health, or related field AND Minimum five (5) years of health care experience or a directly related field OR Minimum eight (8) years of experience in health care or a directly related field.
• Registered Nurse License (California)

Nice To Haves

• Knowledge, Skills, and Abilities (KSAs): Negotiation; Risk Management; Compliance Management; Health Care Compliance; Health Care Policy; Health Care Data Analytics; Learning Measurement; Community Health; Health Care Coding; Consulting; Managing Diverse Relationships; Delegation; Development Planning; Project Management; Risk Assessment; Health Care Quality Standards; Quality Improvement; Quality Assurance and Effectiveness; Evidence-Based Medicine Principles; Infection Control

Responsibilities

• Creates and advocates for developmental opportunities for others; builds collaborative, cross-functional relationships.
• Solicits and acts on performance feedback; works with leaders and employees to set goals and provide open feedback and coaching to drive performance improvement.
• Pursues professional growth; hires, trains, and develops talent for growth opportunities; strategically evaluates talent for succession planning; sets performance management guidelines and expectations across teams / units.
• Oversees implementation, adapts, and stays up to date with organizational change, challenges, feedback, best practices, processes, and industry trends; shares best practices within and across teams.
• Fosters open dialogue amongst team members, engages, motivates, and promotes collaboration within and across teams; motivates teams to meet business objectives.
• Delegates tasks and decisions as appropriate; provides appropriate support, guidance and scope; encourages development and consideration of options in decision making; fosters access to stakeholders.
• Manages designated units or teams by translating business plans into tactical action items; oversees the completion of work assignments and identifies opportunities for improvement; ensures all policies and procedures are followed; partners with key stakeholders and business leaders to ensure products and/or services meet requirements and expectations while aligning with departmental strategies.
• Aligns team efforts; builds accountability for and measuring progress in achieving results; assumes responsibility for decision making; fosters direct reports to resolve escalated issues as appropriate.
• Communicates goals and objectives; incorporates resources, costs, and forecasts into team and unit plans; ensures matrixed resources are fulfilling service or performance requirements across reporting lines.
• Removes obstacles that impact performance; identifies and addresses improvement opportunities; guides performance and develops contingency plans accordingly; influences teams and units to operate in alignment with operational and business objectives.
• Serves as the subject matter expert for clinical quality improvement processes and regulations for within departments, facilities, internal and external committees, and key stakeholders.
• Manages the quality of care complaints and review process by directing the grievance meetings, cases, reviews, referrals, and other mechanisms by collaborating with key stakeholders, the ombudsman, and external regulatory services.
• Manages risk management efforts by leading corrective action plan for areas of improvement identified through utilization review, clinical records audit, claim denials, patient satisfaction surveys, and auditing surveys across departments and regions.
• Manages the development of new clinical quality improvement programs by developing relationships with departments, key stakeholders, and senior management to identify and develop new programs with guidelines, metrics, and operational definitions of quality improvement.
• Manages the systems, procedures, and forms to improve data management programs and utilizes data to monitor and improve performance of all worker and patient safety programs.
• Manages regulatory audits and survey efforts by serving as the primary contact between applicable government, regulatory, and key stakeholders for onsite visits and evaluations.
• Manages the evaluation of the cost effectiveness, practicality, and appropriateness of medical care given to patients by conducting routine case reviews with practitioners.

What This Job Offers

• Career Level: Senior
• Industry: Ambulatory Health Care Services
• Education Level: Bachelor's degree