Senior Clinical Quality Improvement Manager

DeKalb Health; Alameda (CA); Hybrid; USD 167,000 - 251,000; Full time

Job summary

The Alliance seeks a skilled Quality Improvement Clinical Manager to oversee clinical safety activities and drive continuous quality improvement across multiple departments. You will ensure regulatory compliance, lead corrective action plans, and monitor interventions to improve care for members.

Responsibilities include developing workflows for FSR/PQI/PPC/G&A, managing LTC quality monitoring, conducting root-cause analyses, and shaping quality assurance processes.

Qualifications

• California licensed Registered Nurse.
• Bachelor’s degree in health-related field preferred. BSN is strongly preferred.
• A Master’s degree may substitute for two years of the required experience, or an equivalent combination of education and experience which would provide the required knowledge, skills, and abilities may be qualifying
• 4 years of experience in a managed care organization.
• Experience in FSR, PQI, G&A, quality management, patient safety, or care coordination strongly preferred.
• Previous experience in a leadership role required.

Responsibilities

• Oversee operational and tactical strategies for clinical safety activities to promote detection, prevention, and remediation.
• Lead cross-functional meetings to address system trends based on monitoring issues, findings, or analysis of clinical safety activities and other data points
• Develop and implement process improvements or workflows relating to FSR, PQI, PPC, G&A or other related clinical quality activities that improve efficiency or effectiveness
• Collaborates with other departments (i.e. Provider Services, Compliance, etc.) for cases requiring escalation and/or address barriers to ensure timely closure of corrective action plans
• Manages the Skilled Nursing Facility/Long Term Care (LTC) quality monitoring program in collaboration with the LTC to ensure safe care for members
• Manages ad hoc chart reviews to assess, address, or monitor quality of care issues, trends, regulatory audit findings, or strategic priorities
• Contributes toward clinical key performance indicators at Joint Operating Meetings
• Conducts cross-functional root cause analysis and action plans to address quality of care issues
• Develops inter-rater reliability and quality assurance processes to ensure accuracy, appropriateness, and competency to process PQIs and Grievance and Appeals cases
• Develops, updates, and maintains policies and procedures, standard operating procedures, and other operational documents pertaining to the clinical safety unit
• Contributes to the Quality Improvement Health Equity (QIHE) Program trilogy documents (evaluation, program description, and workplans) and related documentation
• Facilitate clinical quality oversight through periodic reviews, chart audits, and reporting of key performance indicators.
• Addresses complex quality of care problems and facilitate an integrated approach to improvement initiatives
• Develops a comprehensive approach to achieving internal and external standards for quality and clinical safety.
• Develops and maintain dashboards for providers with defined expected outcomes & benchmarks based on clinical quality
• Provide contributions and clinical expertise relating to quality measures (i.e. HEDIS), Performance Improvement Projects (PIPs) and Quality Improvement Projects (QIPs), and other strategic initiatives
• Provides in-person and/or virtual training on clinical processes to support clinical safety initiatives
• Manages staff to ensure adherence of policy and procedures, standard operating procedures, and regulatory requirements
• Perform other duties and special projects as assigned.

Skills

Data analysis

Regulatory compliance

Cross-functional collaboration

Training and development

Leadership

Quality improvement

Root cause analysis

Communication

Education

California RN license

Bachelor's degree in health-related field

BSN preferred

Master's degree may substitute for experience

Tools

Microsoft Word

Microsoft Excel

PowerPoint

Windows OS

Job description

The Alliance seeks a skilled Quality Improvement Clinical Manager to oversee clinical safety activities and drive continuous quality improvement across multiple departments. You will ensure regulatory compliance, lead corrective action plans, and monitor interventions to improve care for members.

Responsibilities include developing workflows for FSR/PQI/PPC/G&A, managing LTC quality monitoring, conducting root-cause analyses, and shaping quality assurance processes.